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[Clinical Article] Lower Incisor Extraction with Six Month Smiles®

by 6monthsmiles, on 4/8/15 3:03 PM

Marcie, a 21 year old female, came to our practice hoping to improve the appearance of her smile. Her chief complaint was her crowded upper and lower incisors.

A full examination was carried out and some photographs were taken to properly assess her dentition. Marcie hadn't been to a dentist in a number of years and a certain degree of dental neglect was noted. She had a few carious teeth requiring fillings and she had extensive gingivitis due to her poor oral health.

By: Dr. Maurice O'Brien, Six Month Smiles Provider®


The photos showed that Marcie had fairly minor crowding in the upper arch and more severe crowding in the lower arch. She also had a cross bite with her lower right canine and had a slight tendency towards a Class 3 jaw relationship. Due to the extent of lower arch crowding and the jaw position, I felt that a lower incisor extraction would be needed.

I discussed the option of referring Marcie for comprehensive orthodontic treatment, but she wasn't keen on this due to the time it would likely take to complete the treatment. We made appointments for Marcie to get her teeth cleaned up by the Hygienist and to have the necessary restorations before we took impressions for Six Month Smiles braces. A payment schedule was also arranged.

Marcie's braces-on appointment was at the beginning of December. I extracted her lower right central incisor, as this had the greatest amount of gingival recession. When I sent in my case to Six Month Smiles, I asked them to rotate the brackets on lower left central counter-clockwise, and lower right lateral clockwise by 10 degrees to help bring the roots of these teeth closer as the space was closed. Minor IPR was carried out on the upper arch and .014 wires were fitted. Powerchain was attached from LL central to LR lateral.

I saw Marcie again in mid-January for her first adjustment. She was doing really well, no report of any problems. We replaced the arch wire to .016 on the upper and pc stretched from LL canine to LR canine.

We continued to following normal 6MS protocol in her remaining appointments. By August, all the teeth were nicely aligned and spaces closed. We followed 6MS retention protocols, and placed a permanent retainer on both arches. Final photos were taken and removable retainers fitted a week later. Both Marcie and I were delighted with the result.



As can be seen in the after photos, Marcie has a much larger resting smile than before treatment, she is much more confident with her smile now that she has straight teeth. Also of note is how much her gingival health has improved, with her teeth being straighter it's easier for Marcie to keep her teeth clean.

Observations and lessons learned from this case:

  • Straight teeth make it easier to implement good oral hygiene practices.
  • Patients love having straight teeth and show it with a much bigger smile.
  • Good communication with the Six Month Smiles® Case Processing Facility will allow them to place the brackets in the ideal position which enables smooth treatment.
  • I could have completed this case at least two months earlier, but the patient disappeared for her college holidays for all of April and July.

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Topics:Clinical Information


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