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ORTHODONTICS
ORTHODONTICS

A Six-Month Orthodontic Solution to Space Closure and Bite Collapse

2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD

Clifton C.

Georgaklis,

DMD

F or patients who exhibit missing poste- rior teeth, bruxism, and a concomi- tant loss of vertical dimension often

with commonly occurring anterior flaring and spacing 1 (Figures 1 to 3); mainstream treatment consists of 1.5 to 2 years of ortho- dontic treatment to retract the anteriors and

re-establish the collapsed vertical dimen- sion. This is usually followed by removable retainer wear. It is important to restore the missing posterior support, 2 so the patient can be given implants or bridges afterward.

CASE REPORT

2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD
2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD

F igures 1 and 2. Note palatal occlusion.

2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD
2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD
2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD

F igure 3. Note attrition.

2 ORTHODONTICS A Six-Month Orthodontic Solution to Space Closure and Bite Collapse Clifton C. Georgaklis, DMD

A patient who came to our general prac- tice was given this treatment plan by 2 pre- v i o u s d e n t i st s w i t h s p e c i a l i st s i n t h e i r offices. Eager to seek other alternatives, she

presented for attenuated orthodontic and restorative treatment. Treatment consisted of short-term, 6- m o n t h , f i x e d - o r t h o d o n t i c t r e a t m e n t b y retracting the incisors to their original posi- tion before they migrated forward. The col- l aps ed ve rti c a l dimension wa s inc r e a s ed through use of an anterior fixed composite bite plane. This is a flat-planed composite bit e pl ane bonded to the lingua l of the

F igures 4 and 5. Composite bite plane on teeth Nos. 6, 8, 9, and 11 intruded the anteriors and allowed passive eruption of posteriors.

F igure 6. Af ter bridge cementation. Additional whitening procedures were recommended.

adult patient with fully formed dental arch- es and some bone loss. 5,6 In addition, our practice occupies a niche in treating adults through short-term cosmetic orthodontics, 7 and this demographic desires retention that is aesthetic. Furthermore, treatment is ortho- dontic in these cases and not orthopedic, so the results are less stable, thus requiring fixed r e t e n t i o n . A l i n g u a l c o m p o si t e s p l i n t (Ribbond [Ribbond.com]), where composite covers most of the tooth’s lingual aspect and

plan, they should be placed before or during orthodontic treatment, not after. This case utilized 3 fixed bridges, helping to correct some mesial drift which may be caused by transseptal fiber contraction. 10 Temporary bridges were inserted the day the braces were removed, and the splints were placed. Permanent impressions were taken 1 month later to allow for gingival healing and minor occlusal settling (Figures 7a and 7b).

u p p e r c e n t r a l i n c i s o r s 3 (Figures 4 to 6), prohibit- ing full closure. Through l a c k o f p o st e r i o r o c c l u - sion, within 3 to 4 months the posterior teeth exhib- i t e d si g n i f i c a n t p a ssi v e s u p r a - e r u p t i o n , e v e n without posterior vertical elastic wear (which may be used as an option to accelerate the process). At the same time, the incisor r e g i o n i s i n t r u d e d t h r o u g h c h e w i n g . T h i s o c c u r s t h r o u g h o u t t h e

Before
Before

F igure 7a and 7b. Before and Af ter.

After
After

entire anterior region, as the teeth are essen- tially “splinted” through the orthodontic wire. In this way, even teeth without the composite bite plane are intruded. The ratio of posterior extrusion to anterior intrusion has been shown to be approximately 60:40. 4

DISCUSSION

Secure retention is an essential aspect of this case. Removable retainers are inade- quate, as even slight space relapse will be cosmetically obvious; and this is likely in an

can overlap onto the buccal aspect, is pre- ferred. This can serve to augment small teeth, change shape and width by enhanc- ing line angles, fill chips, and restore sur- faces with attrition. 8 In conjunc tion with the orthodonti c space closure, posterior support must be provided, as the splint will fracture without posterior protection and incisor flaring will return. 9 The increased vertical dimension w o u l d a ls o b e l o st , si n c e t h e p o st e ri o rs would intrude. If implants are part of this

CONCLUSION

This tr eatment approach shows a rapid,

straightforward solution for this common functional and aesthetic dental problem, which is frequently treated with a more complicated long-term plan, often prone to relapse.

References

  • 1. Kelly JT Jr. A multidisciplinar y approach to restoring pos- t e r i o r b i t e c o l l a p s e. C o m p e n d C o n t i n E d u c D e n t . 1997;18:483-485, 488-490.

  • 2. Reshad M, Jivraj S. The influence of posterior occlusion when restoring anterior teeth. J Calif Dent Assoc. 2008;36:567-574.

  • 3. Georgaklis CC. Alter native or thodontic treatment for adult crossbites and overbites. Dent Today. 2001;20:60-
    63.

  • 4. Lei Y, Zhang S. Clinical study on the or thodontic treat- ment of deep overbite with bite plane [in Chinese]. Hunan Yi Ke Da Xue Xue Bao. 1998;23:465-466.

  • 5. Brunsvold MA. Pathologic tooth migration. J Periodontol. 2005;76:859-866.

  • 6. Mar tinez-Canut P, Carrasquer A, Magán R, et al. A study on factors associated with pathologic tooth migration. J Clin Periodontol. 1997;24: 492-497.

  • 7. Georgaklis CC. Six-month adult aesthetic or thodontic treatment. Dent Today. 1999;18:110-113.

  • 8. Georgaklis CC. Anterior retention with a reinforced com- posite resin splint after cosmetic or thodontic treatment. Dent Today. 2002;21:54-57.

  • 9. Greenstein G, Cavallaro J, Scharf D, et al. Differential

diagnosis and management of flared maxillar y anterior teeth. J Am Dent Assoc. 2008;139:715-723. 10. van Beek H. Disser tation 25 years later. 1. Mesial drift of teeth by occlusal forces [ar ticle in Dutch]. Ned Tijdschr Tandheelkd. 2004;111:48-51.

DENTISTRYTODAY.COM • DECEMBER 2009

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ORTHODONTICS

A Six-Month Or thodontic Solution...

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Dr. Georgaklis originated the concept of 6- month adult cosmetic or thodontics in his Boston practice in 1991. He has employed it since 1991, and has been publishing and lec- turing on various aspects of the concept since 1999. He can be reached at (617) 277-5200, or visit rapidbraces.com.

Disclosure: Dr. Georgaklis repor ts no conflicts of interest.

DENTISTRYTODAY.COM • DECEMBER 2009

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