Inital Exam
Chief Complaints
- “I have to strain my lips to close my mouth”
- Gummy smile
- Strained smile
Diagnosis
- Bimax lip protrusion
- Center Midlines
- Broaden Smile
Treatment Plan
- Extract UR 4, UL5 for Midline/lip incompetence
- Gingivectomy for gingival architecture
- Working diagnosis on upper gingival
- 18 months of treatment
Inital Bonding
Torque Selection
Upper
- Regular Torque Upper 3’s
- Low Torque Upper 2-2
Lower
- Lower 2-2- Low Torque
- Lower 3s-High Torque
Month 15
Wire Progression
Upper: 19×25 SS
Lower: 17×25 TMA
TAD’s
Used lidocaine topical and placed TADs btwn U 1-2 and U 5-6, used PC to hook TAds to UAW, hooked up springs from U post to 7’s
Month 18
Wire Progression
Upper: 19×25 SS
Lower: 17×25 TMA
TAD’s
We used a 150 gram 10mm nickel titanium spring and activated it about a half a bracket of coil. (very light forces!)
Comments
We have used a tie back that goes from the post on the wire to the 6s to keep any space from opening up in the posterior.
We have also continued to wire tie both the upper and lower anteriors to keep the spaces closed as well.
Month 19
Comments
We’ve actively been retracting the lower arch for three months now and look what’s happening to the upper arch without any elastics or any rubber bands. The occlusal plane is changing just from us retracting the lower arch and getting the tongue out of the way of the bite. Things are starting to come together now.
Before & After
