A 33 yr old female patient presented at the practice wanting veneers for 6 upper teeth. She was also aware that she grinds her teeth at night.
Clinically she presented with a Class 2, Div 2 Malocclusion complicated by a deep overbite and asymmetrical gingival contour and after discussing with her all the treatment options and the risks of veneers fracturing due to bruxism and the invasive preparations that would be required on her canines, she selected the Six Month Smiles® treatment option.
Her chief complaint was that she hated her "fangy" smile especially the left side.
Dr. Kathrada's patient's "fangy" smile before treatment.
We asked the lab to set the upper incisor brackets to idealize the incisal levels. This would effectively intrude the upper incisors, opening the deep bite. At braces on, we placed second molar bite guards and long tied the upper canines through first molars for added anchorage until the arch wire had a chance to level the upper arch enough that the lower brackets were clear of contact. The patient was then offered an opportunity to open her bite further by placing anterior bite guards and posterior box elastics which she declined. It was also possible to control upper incisor proclination and mitigate the increase in overjet by adjusting the upper IPR.
The patient during Six Month Smiles® Treatment.
Challenges During Treatment
The biggest challenge faced during treatment was severe bruising in the right buccal mucosa at the level of the lower right second bicuspid. Due to the space between lower right second bicuspid and the lower right second molar, the arch wire was digging into the patient's mucosa causing pain and ulceration. This was overcome by cutting the archwire distal to the LR second bicuspid and placing flowable composite on the cut end of the wire to prevent any bruising. Another option would have been to place a tube over the arch wire on the affected side.
Dr. Kathrada's patient after Six Month Smiles®.
The Final Result
The adult braces treatment took 5.5 months to complete and the patient was absolutely thrilled with the result so much so that she mentioned it in her blog. I just want to thank, our great Six Month Smiles Instructors and Mentors for being able to achieve this fantastic "six month braces" result. Also, a special thank you to Dr. Noel Ananthan for his generous (and at times) almost instant advice on cases. This is easy.
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