Jenna’s Case Study

Video

Inital Exam

Chief Complaints
  • Jenna has trauma on her Upper centrals, and her UR2 due to a swimming pool accident.
    • We can’t do a root canal because the apexes of the roots aren’t fully closed yet.
    • Luckily the waterpark was able to retrieve the teeth from cleaning the pool filters!
      • The cosmetic dentist that is involved wanted to wait to re attach the enamel until root canals are performed and the teeth were in the right spot.
Treatment Plan
  • Stabilize the injured teeth until the periodontal ligament has healed and root canals can be performed.
  • Use light PSL forces to extrude the injured teeth and create a beautiful smile!

Inital Bonding

Initial Setup

  • I wanted to keep the forces really light on those injured teeth so I started out with an .012 CuNiTi wire to stabilize the teeth and start slowly moving them back in to position.

Month 1

Wire Progression

Upper: .016 CuNi

Comments

Notice how the tissues are starting to heal and the teeth are slowly falling back in to place.

Month 2

Wire Progression

Upper: .018 CuNiTi

Comments:
  • This visit we moved up to an .018 CuNiTi, still very slowly advancing treatment.
  • At this point, the tissues look fantastic. She is about ready to get root canals done on the injured teeth and have the enamel reattached to the teeth.

Month 6

Wire Progression

Upper: .018

Comments

At this point in time, Jenna has been able to get root canals done on her injured teeth, and had the original enamel bonded back on her teeth!
Now that her teeth are restored, we are able to reposition the brackets for a great finish.

Month 7

Wire Progression

Upper: 14×25 TMA

Comments

At 6 Months, we put an .018 CuNiTi wire in to make sure we weren’t putting too much stress on the teeth.
At 7 Months, things were looking good enough to advance to a 14×25 TMA.

Month 9

Wire Progression

Upper: 16×25 CuNiTi

Comments

At 8 months we placed a 16×25 CuNiTi and open-coil springs to make room for the cuspids.

We advanced the coil spring by 1/2 a bracket length to slowly start opening up space. Light forces rule!

At the 9 month visit, we kept the same wire and advanced the coil spring by another 1/2 a bracket length. We also repositioned the UR2.

Month 11

At 11 months I placed a 19×25 TMA wire.
Made adjustments to UR1 & Upper 2s and added some lingual torque in to the wire to help upright the centrals. (Sorry I don’t have pictures!)

Month 14

At this point I still wasn’t quite getting enough torque to overcome the flaring in the anteriors, so I switched to a 19×25 PT (pre-torque) wire. These wires have 20 degrees of torque built 2-2. (Again, sorry I don’t have pictures.)

Month 15

Jenna came in for her check debond appointment at 15 months. I made a couple minor adjustments to UR1 & UL2 and sent her to her cosmetic dentist for some gum contouring.

Month 17 – Phase 1 Debond Day

End Phase 1 Notes

At 8 months we placed a 16×25 CuNiTi and open-coil springs to make room for the cuspids.
We advanced the coil spring by 1/2 a bracket length to slowly start opening up space. Light forces rule!
At the 9 month visit, we kept the same wire and advanced the coil spring by another 1/2 a bracket length.

Phase II Start (10 months post Phase I)

Torque Selection
Upper
  • Upper 2-2 Low Torque
    • I had a really hard time overcoming the flared incisors in Phase I, so I chose low torque.
    • I exposed and bonded the upper 3s with high torque brackets
Lower
  • Lower 2-2 Regular Torque
  • Lower 3s High Torque
Bracket Placement
Upper
  • Centrals I placed at 5.5-6mm (from occlusal edge)
  • Laterals I placed at 5-5.2mm (from occlusal edge)
  • Cuspids I placed at 5mm (from occlusal edge)
Lower
  • Cuspids I placed at 5mm (from occlusal edge)
  • Incisors I placed at 4.5mm (from occlusal edge)

Month 9.5

Wire Progression

Initial: .014 CuTi

2 months: 14×25 CuTi

5 months: 18×25 CuTi

11 months 19×25 TMA

Wire Progression

Initial: .014

2 months: 14×25 CuTi

11 Months 17×25 TMA

BeforeĀ  & After

Case Summary

What a transformation for Jenna! This case is a great example of what simple mechanics and light forces can do for our patients, even when there is trauma to the Periodontal Ligament. She finished with a beautiful wide smile and great smile arc.

Because Jenna was Class II to begin with, I had her wear her clear retainers during the day, and a Damon Splint at night to retain the bite.

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