Techniques/Procedures
Orthodontic Therapy
Sometimes prior to comprehensive restorative treatment involving placement of multiple restorations to improve function and esthetics, orthodontic treatment may be recommended first to realign the teeth in their proper position so that minimally invasive dentistry can be performed with greater functional stability and increased longevity of the restorations. Properly aligned dentition in horizontal, vertical, and sagittal dimensions is critical in achieving ideal esthetics and occlusion which requires harmonious relationships among temporal mandibular joint, muscles, and teeth of the masticatory system.
Having that said, traditional orthodontic treatment involves the use of brackets and wire to gradually move teeth to their desire position whereas invisalign, or any type of clear aligners for that matter, employs clear rigid sequential trays to advance teeth to their final and determined position. In general, both systems are effective in orthodontic movement of teeth; however, each system has its' own advantages and limitations depending on the type of tooth movement required.
Invisalign System
Invisalign system is ideal for minor tooth movements especially when rotational and extrusive movements are not involved.
As in this case where this patient presented with minor crowding of her maxillary and mandibular dentitions with no prior orthodontic treatment.
The goal of the treatment is to create adequate space through expansion of dental arches to accommodate the tooth mass and to properly align the dentition.
The completed treatment photos show properly aligned dentition with congruent midlines and with a brighter and whiter smile from whitening treatment performed simultaneously with the Invisalign treatment.
Also at the completion of the treatment, a fixed lingual retainer was placed on the anterior of the mandibular arch and clear Essix retainers were fabricated for both maxillary and mandibular arches for the purpose of retention.
It must be understood that orthodontic retention is a lifetime retention, and it is critical for patients to understand this prior to commencement of any orthodontic treatment.
Traditional Brackets/Wire Therapy
A traditional orthodontic therapy involving the use of brackets to align dentitions are necessary when rotational movements must be incorporated during the process of aligning the teeth. In general, significant rotational and extrusive orthodontic movements are better managed with brackets and wire than with Invisalign system. This is not to say that one system is more superior to the other; however, recognizing the advantages and limitations of both systems is necessary in order to facilitate and enhance the treatment outcome.
This patient presented with a significantly rotated and distally inclined maxillary canines causing spacings among her maxillary anterior teeth resulting in distraction and imbalance in her smile zone. In addition, missing tooth #29 with retained #T resulted in dental midline discrepancy as seen in pre-treatment photographs.
A comprehensive orthodontic treatment with brackets and wire was carried out along with interproximal tooth reduction of #T to first derotate the canines, second to realign dental midline, third to close all spaces, and at last to obtain improved vertical (overbite) and sagittal (overjet) relationships as seen in post-treatment photographs.
As for retention, a set of clear Essix maxillary and mandibular retainers was fabricated at the completion of the treatment.
For esthetic purposes, the gingival symmetry and thus the tooth form of the maxillary incisors can further be enhanced through minor gingivalplasty of maxillary left central and lateral incisors specifically at the zenith to match those of maxillary right central and lateral incisors.
Combination Therapy
Patient presented with discolored and fractured Maxillary right central incisor, chipped Maxillary left incisor, and drift of the Maxillary right lateral incisor. Patient will like to address those issues and enhance his smile.
Maxillary right central incisor with history of trauma was necrotic. Endodontic therapy was performed followed by internal bleaching. A complete healing of the periapical area with bone fill was observed.
A limited orthodontic therapy was carried out on Maxillary dentition to reposition Maxillary right lateral incisor into it's original position to obtain right and left symmetry and to obtain more favorable tip and torque of the maxillary dentitions. A full mouth bleaching was done and gingivoplasty or gum lift was also performed on the central incisors to obtain proper gingival height and symmetry in relation to those of lateral incisors and canines. Finally, the central incisors were very conservatively prepared for veneers which were then fabricated with CEREC technology and bonded in place. This case shows the integration of various disciplines in dentistry in addressing patient's concerns and achieving a successful result.
