Treatment with the SPEED System™ - Class I Non-Extraction 4 Case Type: Class I Non-Extraction Problem List: • Brachycephalic pattern • Low Mandibular Plane Angle • Short Lower Face • Poor Upper and Lower Lip Support • Clenching • Parafunction Case Resumé: A young lady, age 21 years. Growth is finished and she has relatively good posterior occlusion but has traumatic occlusion in the anterior section, due to her large overbite. The patient came to the office because of the discolouration and sensitivity of her upper right lateral incisor. She has a normal overjet of 2.5 mm, but a large overbite (6 mm). A Maryland bridge was masking her impacted canine, and the mesial wing bonded to the adjacent lateral is responsible for the discolouration of this tooth, and has resulted in traumatic occlusion of the lateral, resulting in gingival recession and sensitivity due to parafunction. On the panoramic X-ray, we can see a bony defect distal to the tooth 12 and the impacted upper right canine. We can also see 3 impacted wisdom teeth (18, 28, 48) and root dilaceration of tooth 15, 25, 35, 43, and 45. The curve of Spee is almost normal. Treatment Plan: The patient was sent to the periodontist to evaluate the gingival tissue and recession prior to the start of treatment. The Periodontist decided to evaluate the recession as treatment progressed and re-evaluate the case once the Orthodontic treatment was completed. Maxillary Arch: Remove the Maryland bridge, initiate dental alignment and create space in the arch for the impacted canine (13). Work up to a rectangular wire to prepare anchorage for orthodontic traction of the impacted canine. Next steps are to align the canine, coordinate arches, and finally, retention. At the end of treatment, re-evaluate the gingival tissue and the recession with the periodontist, and send the patient to the General Dentist to have cosmetic procedures to compensate for the incisal attrition of the upper incisors, if needed. Mandibular Arch: Align the teeth, correct the curve of Spee, coordinate the arches using rectangular archwire, and if needed, incorporate anchorage using Class II elastics. Retention with a lingual bonded retainer, and re-evaluate the periodontics on the right side, particularly for tooth numbers 43, 44, and 45. Case Presentation by: Dr. François Bérubé D.M.D. Cert. Orth. - Québec City, Canada Comments from Dr. Bérubé I have used the SPEED Appliance since the start of my practice in 1986 because it offers many benefits. SPEED permits me to efficiently achieve my treatment objectives through the application of light forces applied in a very precise manner. I have successfully treated thousands of cases with SPEED over the past 27 years, and I have been very satisfied with what it has enabled me to achieve. This case is typical of those seen everyday in my practice. It illustrates SPEED's ability to correct crowding and its ability to resolve ectopic displacement of an impacted tooth while maintaining archform. The combination of light forces with the miniaturized SPEED bracket permitted large dental movement without root resorption, permitted bone formation and thereby reduction of the periodontal defect, while it also improved the gingival anatomy around the initially impacted tooth. The horizontal auxiliary slot of the SPEED bracket permitted the application of parallel and simultaneous mechanics within the same dental arch. A component of these mechanics was anchorage with large archwires which prevented undesired side effects caused by secondary light wire force application on the impacted tooth. The accuracy of the bracket placement and the effectiveness of the spring clip has led to a complete dental correction in all three dental orders. • Masticatory Muscle Pain • Gingival Recession - tooth 12, 14, 43, 44, 45 • Upper and Lower incisor attrition • Upper Right Impacted Canine • Upper and Lower Crowding
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