"Stacie" is 29 years old and presented with a chief complaint of wanting to address the spacing between her teeth. She had no specific concerns regarding the overjet or deep bite and had previously had a comprehensive ortho consult in which she was advised that she would require orthognathic surgery in conjunction with full fixed orthodontic treatment.
This patients treatment is a perfect showcase of the power of Six Month Smiles teeth straightening in treating seemingly complex challenges with familiar techniques when you have an understanding of how they can be applied.
My treatment plan simply involved creating the interarch clearance needed to retract the upper anteriors and, as intimidating as it initially appears, the actual treatment was a very routine process. At braces on, I placed biteguards on the upper canines, full upper arch elastic thread, and powerchain from upper canine to canine and lower canines through first molars. My preferred protocol for dealing with spaced cases is to retract the canines first and then long tie the canines through first molars, for anchorage and stability. Then, I use canine to canine powerchain for more efficient anterior space closure and retraction. This also allows time to generally align the teeth and, if full arch elastic thread is used under the arch wire, anterior retraction will be started as well.
We saw Stacie on a 2 week adjustment schedule, changing the powerchain each time and the elastic thread every 4 weeks in order to maintain elastic pull. This was important because powerchain, elastic thread, and even donuts lose their elasticity and effectiveness with time, especially in the harsh oral environment. The only real challenge here was the amount of bite opening needed to allow full upper retraction and space closure. I actually added to the biteguards twice after braces on, once mid-treatment and again near the end of treatment to ensure adequate clearance for the upper fixed retainer. With each increase in the biteguards, we started Stacie on posterior box elastic use again to close the posterior bite. Toward the end of treatment, I repositioned the brackets on the upper centrals rotated 10 degrees (counterclockwise for the upper right and clockwise for the upper left) in order to correct the mesial tipping that often occurs with space closure.
We finished with electrosurgical gingival recontouring to enhance the proportions of the upper teeth and reduce slightly the gumminess of the smile. I waited until immediately following the recontouring to take the impression for the upper Essix retainer and had Stacie wait in the office as we fabricated it. This immediate delivery allowed the Essix to act as a healing stent for the gingival tissues and minimize any ‘creeping’ back. Total treatment time was 7 months.
Stacie was ecstatic with her new smile. She said that she couldn’t stop staring at it in the mirror - something that we all hear often from our patients and part of what makes Six Month Smiles so gratifying.
Dr. Ananthan graduated from the University of Toronto's Faculty of Dentistry in 1986 where he gained early acceptance after one year of undergraduate study. He immediately opened his own private practice, focusing on comprehensive and aesthetic dentistry. Six Month Smiles has allowed him to re-integrate orthodontics, into his practice both as a standalone treatment and adjunct to his comprehensive cases.