20130115 beethoven orthodontic course textbook review Contemporary ortho 5e chap 18 part 2

4. CHAPTER 18
Special Considerations in Treatment for Adults, 623
William R. Proffit, David M. Sarver
Adjunctive vs Comprehensive Treatment, 624
Goals of Adjunctive Treatment, 624
Principles of Adjunctive Treatment, 624
Adjunctive Treatment Procedures, 627
Comprehensive Treatment in Adults, 637
Special Aspects of Orthodontic Therapy for Adults,
661

5. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements
required, the anchorage available, the periodontal FIGURE 18-20
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model, patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

6. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Ortho. Closure ?
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
Restorations ?
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements
required, the anchorage available, the periodontal FIGURE 18-20
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model, patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

7. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Ortho. Closure ?
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
Restorations ?
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements
required, the anchorage available, the periodontal FIGURE 18-20
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
Diagnostic Setup
The major indication for adjunctive orthodontic
treatment to correct malaligned anterior teeth is
tooth-size discrepancy, composite buildups are an excellent
solution, but satisfactory esthetics may require redistribution of
the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model, patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

8. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movementsª›®œ•Œ QuickTime˛ ©M
required, the anchorage available, the periodontal
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support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and
FIGURE 14-1 Pre-Tx. Dx. Setup or Digital simulation
Pre-Tx. Dx. Setup or Digital simulation
the malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
the frenum was not performed, partially in deference to the
patient's age. H, Appearance on smile before and (I) after
treatment.
new position. If digital casts are available, a modern636

9. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements
required, the anchorage available, the periodontal
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model,
FIGURE 18-20 patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

10. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements 16 mil steel
required, the anchorage available, the periodontal
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model,
FIGURE 18-20 patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

11. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements
required, the anchorage available, the periodontal
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model,
FIGURE 18-20 patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

12. which is often further complicated by irregular
spacing related to small or missing lateral incisors
(Figure 18-20). A "diagnostic setup" is very helpful
in planning the correction of such problems. For this
Alignment of Anterior Teeth
procedure, the study casts are duplicated and the
malaligned teeth are carefully cut from the model,
repositioned, and then waxed back onto the cast in a
new position. If digital casts are available, a modern
alternative is to do this on a computer screen (see
Figure14-1), and this is part of routine treatment
planning when a sequence of clear aligners will be
used in comprehensive treatment (see below). This
allows evaluation of the feasibility of the orthodontic
treatment in light of the crown and root movements 21.5 mil
required, the anchorage available, the periodontal
support for each tooth, and the possible occlusal
interferences. If spacing of maxillary incisors is related to small teeth and a
tooth-size discrepancy, composite buildups are an excellent
The major indication for adjunctive orthodontic solution, but satisfactory esthetics may require redistribution of
treatment to correct malaligned anterior teeth is the space before the restorations are placed, as in this patient who
preparation for buildups, veneers, or implants to was concerned about his large central diastema. A and B, Before
treatment, age 48. C and D, Redistribution of the space using a
improve the appearance of the maxillary incisor teeth. fixed appliance with coil springs on a 16 mil steel archwire
The most frequent problem is a maxillary central immediately before removal of the orthodontic appliance and
diastema, which is often further complicated by placement of the restorations (to be done the same day). A17.5 mil
multistrand steel wire was used for initial alignment before the
irregular spacing related to small or missing lateral coil springs were placed. Eand F, Completed restorations
incisors (Figure 18-20). A "diagnostic setup" is very (composite buildups). G, Note the fixed retainer of bonded 21.5
helpful in planning the correction of such problems. mil multistrand wire on the lingual of the central incisors to
prevent partial reopening of the midline space. Surgical revision of
For this procedure, the study casts are duplicated and the frenum was not performed, partially in deference to the
the malaligned teeth are carefully cut from the model,
FIGURE 18-20 patient's age. H, Appearance on smile before and (I) after
repositioned, and then waxed back onto the cast in a treatment.
new position. If digital casts are available, a modern636

13. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
FIGURE 18-21
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
this patient, aligning the lower incisors without extraction would also
considered. The key question is whether the require aligning the upper incisors, but this expansion would increase
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
the lower right central incisor. B, Mandibular occlusal view. C, Frontal
tooth to provide space,8 or removing one lower view. Note the moderately deep bite and lack of overjet. The restorative
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
after alignment. E, Frontal view. F, Smile after restoration was
appliance is more efficient and cost-effective completed.
(Figure 18-21). A segment of A-NiTi wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into alignment (see
Figure 14-5). FIGURE 14-5
).
637

14. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
FIGURE 18-21
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
Ext. ?
patient to maintain the teeth. In some cases,
align the remaining teeth, or align the teeth with arch expansion and
restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
Expansion?
considered. The key question is whether the this patient, aligning the lower incisors without extraction would also
require aligning the upper incisors, but this expansion would increase
crowding should be resolved by expanding the arch,
Inter-proximal Reduction
removing some interproximal enamel from each
lip support and improve the overall facial appearance as well as the
dental appearance. A, Smile before treatment, after loss of one corner of
the lower right central incisor. B, Mandibular occlusal view. C, Frontal
incisor. (IPR)?
tooth to provide space,8 or removing one lower
Expansion of a crowded incisor segment
view. Note the moderately deep bite and lack of overjet. The restorative
dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
after alignment. E, Frontal view. F, Smile after restoration was
appliance is more efficient and cost-effective completed.
(Figure 18-21). A segment of A-NiTi wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into alignment (see
Figure 14-5). FIGURE 14-5
).
637

15. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
this patient, aligning the lower incisors without extraction would also
considered. The key question is whether the require aligning the upper incisors, but this expansion would increase
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
the lower right central incisor. B, Mandibular occlusal view. C, Frontal
tooth to provide space,8 or removing one lower view. Note the moderately deep bite and lack of overjet. The restorative
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
after alignment. E, Frontal view. F, Smile after restoration was
appliance is more efficient and cost-effective completed.
(Figure 18-21). A segment of A-NiTi wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into alignment (see
Figure 14-5). FIGURE 14-5
FIGURE 18-21
).
637

16. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
this patient, aligning the lower incisors without extraction would also
considered. The key question is whether the require aligning the upper incisors, but this expansion would increase
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
the lower right central incisor. B, Mandibular occlusal view. C, Frontal
tooth to provide space,8 or removing one lower view. Note the moderately deep bite and lack of overjet. The restorative
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
after alignment. E, Frontal view. F, Smile after restoration was
appliance is more efficient and cost-effective completed.
(Figure 18-21). A segment of A-NiTi wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into alignment (see
Figure 14-5). FIGURE 14-5
FIGURE 18-21
).
637

17. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
considered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase
require aligning the
the lower incisors without extraction would also
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
tooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative
view. Note the
central incisor.
bite and lack
occlusal view. C, Frontal
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
appliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was
completed.
(Figure 18-21). A segment of A-NiTi of one lower incisor !!
No ext. wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into No braces on upper !!
alignment (see
Figure 14-5). Only 5 month tx. time14-5
FIGURE !!
FIGURE 18-21
).
It seems no IPR !!
637

18. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
considered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase
require aligning the
the lower incisors without extraction would also
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
tooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative
view. Note the
central incisor.
bite and lack
occlusal view. C, Frontal
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
appliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was
completed.
(Figure 18-21). A segment of A-NiTi of one lower incisor !!
No ext. wire, with
?
stops to make it slightly advanced, usually is the
best way to bring the teeth into No braces on upper !!
alignment (see
Figure 14-5). Only 5 month tx. time14-5
FIGURE !!
FIGURE 18-21
).
It seems no IPR !!
637

19. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
considered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase
require aligning the
the lower incisors without extraction would also
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
tooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative
view. Note the
central incisor.
bite and lack
occlusal view. C, Frontal
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
Crimped stop
lower arch is to be treated, the esthetics of the on both arches, after which the incisor would be restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
appliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was
completed.
(Figure 18-21). A segment of A-NiTi wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into alignment (see
Figure 14-5). FIGURE 14-5
).FIGURE 14-5
637

20. Alignment of Anterior Teeth
Crowded, Rotated, and Displaced Incisors As a
rule, spacing is the problem when maxillary incisors
need realignment to facilitate other treatment.
Crowding usually is the problem when alignment of In an adult with a damaged lower incisor (in this case, the left central
lower incisors is considered to provide access for incisor with a crown fracture) and incisor crowding, there are two
restorations, achieve better occlusion, or enable the treatment possibilities: extract the damaged tooth and use the space to
align the remaining teeth, or align the teeth with arch expansion and
patient to maintain the teeth. In some cases, restore the damaged one. The decision has an esthetic component
alignment of incisors in both arches must be because the lower incisors are visible on smile in older individuals. In
considered. The key question is whether the this patient, aligningupper incisors, but this expansion would increase
require aligning the
the lower incisors without extraction would also
crowding should be resolved by expanding the arch, lip support and improve the overall facial appearance as well as the
removing some interproximal enamel from each dental appearance. A, Smile before treatment, after loss of one corner of
tooth to provide space,8 or removing one lower the lower right moderately deepB, Mandibular of overjet. The restorative
view. Note the
central incisor.
bite and lack
occlusal view. C, Frontal
incisor. Expansion of a crowded incisor segment dentist sought orthodontic consultation, thinking that extraction of the
can be done with clear aligners, but if only the damaged tooth might be the best plan. The patient wanted the best
esthetic result and accepted a period of treatment with a fixed appliance
lower arch is to be treated, the esthetics of the on both arches, after which the incisorOpenbecoil first
Crimped stop would restored. The
appliance is not a consideration, and a partial fixed orthodontic alignment required 5 months. 0, Mandibular occlusal view
appliance is more efficient and cost-effective after alignment. E, Frontal view. F, Smile after restoration was
completed.
(Figure 18-21). A segment of A-NiTi wire, with
stops to make it slightly advanced, usually is the
best way to bring the teeth into alignment (see
Figure 14-5). FIGURE 14-5
).FIGURE 14-5
637

21. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible FIGURE 18-22
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

22. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
Neither stripping nor
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
incisor extraction should
a fixed appliance is removed, a canine-to-canine clip
retainer, or a bonded fixed retainer. 10
incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
Mandibular occlusal. The plan was extraction of the primary incisor and
be undertaken without a
Stripping the contact points of the teeth to remove enamel
can provide space for alignment of mildly irregular lower
closure of the extraction site, using a series of Invisalign aligners and
bonded attachments to produce the necessary rotation and root movement.
diagnostic setup.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After FIGURE 18-22 noted that the maxillary right canine was not
eight aligners it was
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

23. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and 18-22
FIGURE difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

24. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and 18-22
FIGURE difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

25. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and 18-22
FIGURE difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

26. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

27. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

28. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

29. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
Inter-arch Tooth Size Discrepancy
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

30. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
Inter-arch Tooth Size Discrepancy
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

31. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
Inter-arch Tooth Size Discrepancy
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637

32. on overjet, overbite, posterior intercuspation, and esthetics.9
In severe crowding, removing one lower incisor and using
the space to align the other three incisors can produce a
Inter-arch Tooth Size Discrepancy
satisfactory result and can be managed with clear aligner
Alignment of Anterior Teeth
therapy if bonded attachments are part of the treatment plan
(Figure 18-22). The treatment time and difficulty, whatever
the type of appliance, put this at or across the border of
comprehensive treatment. Neither stripping nor incisor
extraction should be undertaken without a diagnostic setup
to verify feasibility. Remember that stretched gingival
fibers are a potent force for relapse after rotations have been
corrected, and that good long-term stability may require a
fiberotomy (see Chapter 16). Whether clear aligners or a
fixed appliance was used, retention is necessary until
restorative or other treatment is completed. This can be the
final aligner in a sequence (though this may be too flexible
to be a good retainer), a molded thermoplastic retainer after This 24-year-old patient had a congenitally missing mandibular right lateral
a fixed appliance is removed, a canine-to-canine clip incisor and a retained but failing primary incisor. A, Frontal view. B,
Maxillary occlusal. Note the rotation of the maxillary right canine. C,
retainer, or a bonded fixed retainer. 10
Mandibular occlusal. The plan was extraction of the primary incisor and
Stripping the contact points of the teeth to remove enamel closure of the extraction site, using a series of Invisalign aligners and
can provide space for alignment of mildly irregular lower bonded attachments to produce the necessary rotation and root movement.
incisors, and either a fixed appliance or a clear aligner Before treatment began, air-rotor stripping of the maxillary posterior
quadrants was done to reduce the tooth-size discrepancy. D, Note the hard-
sequence can provide the tooth movement. This should be to-see bonded attachments on the maxillary right canine and incisors and on
undertaken with caution, however, because it may have an the mandibular right canine and central incisor. The original plan called for
undesirable effect on overjet, overbite, posterior 13 upper and 15 lower aligners, plus three overcorrection aligners. E and F,
intercuspation, and esthetics.9 In severe crowding, removing After eight aligners it was noted that the maxillary right canine was not
tracking, and an elastic to additional bonded attachments was used along
one lower incisor and using the space to align the other three with the aligner to further rotate it. New records were taken, and four upper
incisors can produce a satisfactory result and can be and five lower revision aligners, with three revision overcorrection aligners,
managed with clear aligner therapy if bonded attachments were fabricated. G to I, Completion of treatment. A bonded canine-to-canine
are part of the treatment plan (Figure 18-22). The treatment mandibular retainer was used, and the final maxillary aligner was continued
at night as the maxillary retainer. J, Panoramic radiograph at the completion
time and difficulty, whatever the type of appliance, put this of treatment. Total treatment time was 19 months (which included 2 months
at or across the border of comprehensive treatment. Neither waiting for revision aligners). (Courtesy Dr. W. Gierie.)
stripping nor incisor extraction should be undertaken
without a diagnostic setup to verify feasibility. 637