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Case study Patient-Milkovic-Profile

Case details



Before / After

A before and after image

Milkovic-Before Milkovic-after

Case description

Orthodontics at its maximum – general crowding, inverted bite of the second upper left incisor, closing of the space in places of lost molars in the upper and lower jaw. Apart from the undermined smile esthetics due to general crowding and the second upper left incisor which was placed on the inside of the lower teeth, the patient had previously lost one upper and two lower molars.


Along with taking care of all of the more complex orthodontic problems, we decided to push the boundaries of orthodontic treatment to its maximum and to close the gaps left by lost teeth with the patient’s healthy teeth. In places of lost first molars we moved healthy teeth, the second and third molars.

In order to do that, along with the fixed orthodontic appliance, we set a temporary skeletal anchorage, extraradicularly into the chin area.


The mini-implant was needed as an anchorage for closing the biggest gap left by the lower right molar. In this case, seeing as the therapy in other segments was more complex, the closing procedure lengthened the treatment time by 7-8 months. With this procedure we straightened the second molars which collapsed into the toothless gap. Without orthodontic intervention, this would result in further leaning of the teeth into the toothless gap and their eventual loss. Along with saving the teeth from further deterioration, we also placed them into the gap left by the lost first molars. The root parts of the lower second molars, as shown by the orthopantomograms, had to travel more than 10 millimeters, even though that space seemed less due to the crowns leaning forward.


This way the need for a prosthetic replacement of the teeth was lost and the patient’s treatment expenses were greatly reduced. Apart from the economical aspect, the patient will not have to have her healthy teeth ground down in order to place a bridge. She also won’t have to undergo surgical procedures of placing implants and supplementing lost bone in the toothless areas. Due to that, this procedure is also the best solution medically speaking.

For a more beautiful look, the tips of incisors, which were worn down unevenly before the treatment, were reshaped without prosthetic work like crowns. The only thing left is to replace old prosthetic work on the upper left first premolar.

In the photos of the end of the orthodontic treatment by fixed orthodontic appliance it is visible that the teeth have been placed into ideal occlusion, as well as healthy gums, because we didn’t have to spread the teeth to receive adequate space. All six of Andrew’s keys to occlusion were fulfilled, which is something we always insist on. The basic criteria for long-term stability, health, and ideal chewing function we accomplished were: the correct overlap of the middle of the upper and lower dental arch, class I alignment of the upper molars behind the lower molars, the upper incisors “lean” against the lower incisors and overshoot them vertically by the ideal lengths of 2-3 millimeters, absence of tooth rotation, closing of all gaps between teeth and all back upper teeth placed ideally with the outer bump outside of the outer bump of the lower teeth.

In our opinion, orthodontics are the queen of all dental medicine branches. Only an orthodontics specialist can view an orthodontics case from all aspects and advise the patient about the specific possibilities and potential dangers of their case. This is a prime example of the possibilities and complexities of orthodontics. How the bite has to look after good orthodontics and why orthodontics isn’t magically “aligning” teeth in a couple of months. Every treatment plan needs to be planned in detail, and every step of the orthodontic treatment needs to be correct and questioned on every checkup.

The only correct approach from the start of any orthodontic treatment is the exhaustive informing of the patient of the possibilities of orthodontics in their case. That, as well as informing them of the negative consequences caused by “straightening” teeth without also aligning the bite and by pushing teeth outside of their biological boundaries. With adult patient orthodontics all, and even stricter, child orthodontics tooth moving boundaries apply.