Case details

Category

Closing of the space left by lost first lower molars, crowding, inverted bite of the second upper left incisor.

Case description

The patient came to us with crowding in the upper dental arch, dystopia and inverted bite of the second upper left incisor and with lost first lower molars.

The space to align teeth with an orthodontic appliance, any appliance, can be achieved by one of three ways. By expanding the dental arches, by minimally narrowing the teeth via air rotor stripping method and teeth extraction. By processing diagnostic data, it was established that enough space can be obtained by slight dental arch expansion and air rotor stripping.

Air rotor stripping is a safe method, long used in orthodontics. Many studies were made on the long-term effects of this method and no adverse effects were found on the teeth whose width was reduced by less than 0.3 millimeters on a single plane. Although this is a very small amount, in each dental arch there are 14 teeth with two planes which can be narrowed using this method. This way you can get up to 8.4 millimeters of space per arch.

The thing we are very proud of is the solving of the problem of the missing first lower molars in our 17-year-old patient. This was done in spite of the general opinion of patients and doctors of dental medicine that the only solution for a lost tooth is either a dental bridge or dental implant. This is another one in a series of cases where we’ve shown our way of solving that issue – orthodontic closing of the toothless gap using a bone anchorage with ending the case in ideal occlusion.

The advantages of this approach as opposed to dental bridges or implants are numerous, especially with younger people.

To make dental bridges it is necessary to file down the enamel of at least two neighboring teeth to fix one tooth. Also, the dental bridge needs to be changed throughout life which necessitates additional filing of the prepared teeth along with new economic expenses. Also, the maintaining of ideal oral hygiene with dental bridges is harder than with natural teeth.

Dental implants are popular solutions to missing teeth. But, for a dental implant it is necessary to have enough bone in all three dimensions, and if the teeth were removed a couple of years ago that often isn’t the case. Also, the setting of dental implants with younger people is often postponed until they are 21 or 22 years of age so that the changes in the vertical bone growth can be as minimal as possible. Still, they happen even after that age. The situation is different from individual to individual and then changes to the length of the crown implant and other changes need to be made. All of this, ofcourse, means more visits to your dental medicine doctor and more expenses. Dental implant hygiene calls for more dedication than normal teeth.

The orthodontic filling of toothless space using mini-implants is one of the true recent revolutions available through their use. Sometimes, depending on the anchoring needs, toothless gaps can be closed without using bone anchorages. Mini implants are small screws of a diameter between 1.6 to 2 millimeters and with a length of 6 to 17 millimeters. They allow us to move teeth without placing an anchorage on the teeth we do not want moved. After the teeth are moved into the desired position, mini-implants are removed and the patient is left with their own healthy teeth in places of lost teeth. The only negative side of this solution is a somewhat longer duration of orthodontic treatment. On the other hand, from a biological and economical standpoint this is truly the best solution. In this case, our patient received a second chance for their teeth. With regular and good dental hygiene they will never have a need for any other dental procedures.

The case was finished in ideal occlusion where the upper incisors are leaning against the lower ones, the middles of dental arches are aligned, the upper canines are set behind the lower ones in ideal class I relationship and the inverted bite of the second upper left incisor has been rectified.