Case review

From: Roy King [mailto:rkking@bellsouth.net]
Sent: Saturday, January 01, 2011 12:17 PM
To: ‘The Electronic Study Club for Orthodontics’
Subject: Case review

For ESCO,

I just reviewed a case that I did 8 years ago. She had multiple diastemas from the second premolar forward. About 8 mm of space in the upper and lower arches. I treated her with reciprocal closure(chains or s-coils) and then put an upper and lower fixed (u3-3 and l4-4) . She has broken the fixed and the spaces have reoccurred. I would not be so foolish to do the same type of treatment and expect different results. My question not only how would you handle the case now but in the future, should we all be dragging the molars forward using TADS on all cases that have large generalized spacing(6-8 mm). TADS has caused me to rethink my approach to these kind of cases. I can see that handling the maxilla would be best done by placing a palatal tad and changing theTPA  from the U6’s initially so to push U5-5 forward and then to place TPA on U4’s attached to the TAD and dragging u67 forward with indirect anchorage.  How would you drag the lower molars and premolars. I am thinking of doing a  chain l3-3 and place coils between L56  and drag l4-4 forward with chain and then drag L5-5 forward while ocoil is pushing L5’s. Then place the TAD distal to L3’s for direct or indirect and pull the L67 forward.  MY rational of using an ocoil between L56 is that I do not believe that I will get much distalization on L67 and especially if L8 is present. Any other advice.

Roy King

2 responses to “Case review

  1. Have you considered the easy way of adding an implant and crown to minimize tooth movement and possible root resorption???

  2. Anytime I am retaining a patient with a tendency for spaces to open up, I use back-up removable retainers in addition to fixed retainers. I instruct patients to wear the removables at night, and when the fixed retainers break, wear the removable full time until they can get back to the office for repairs.

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