By Wael Kanaan DDS MSD
Here is another complex case for a 13-year-old girl who visited our office in 2019 with crooked teeth and a small impacted upper right second premolar.
Although she has crowding, her biggest concern was the lack of display of her upper teeth when smiling. So, the challenge in this case is how to make her teeth straight and bring her front top teeth down so she will have enough teeth to display when smiling.
She was looking for an orthodontist in Houston and decided to have an exam with Dr. Kanaan. Her panoramic X-ray revealed an impacted UR5 without enough space and one baby tooth remaining. She does not smile normally because of the high upper left canine and because she does not show enough upper teeth.
Orthodontic treatment with extraction can change the occlusal plane based on the direction of the applied forces.
Dr. Kanaan discussed the different options and challenges of showing more of the front upper teeth while smiling. Treatment options included:
- Performing orthodontic treatment and then jaw surgery,
- Performing orthodontic treatment and then plastic surgery for the upper lip to make it shorter,
- Performing orthodontic treatment by extracting 4 teeth and changing the occlusal plane orthodontically to display more of the upper teeth.
The parents decided to go with the 3rd option and treatment started with traditional braces. After 4 months of treatment, the 4 teeth were extracted and the patient was placed on rubber bands to correct the occlusal plane. This side effect has been confirmed by research as “These side effects include clockwise rotation of the occlusal planes”
The patient did an excellent job wearing her rubber bands causing a temporary over-correction of her bite.
In the end, the bite settled in an excellent way and both the patient and the parents were extremely happy.
The proper extraction pattern with the rubber bands really helped the patient to bring her top teeth down the end result was a fantastic excellent smile with an extremely happy patient.
The treatment took over 32 months and when we analyze her smile we can see that originally she displayed only 2-3 mm of the front top teeth and now she displays 8 to 9mm which is a 300% enhancement in her smile.
A permanent retainer was placed on her lower teeth to maintain the final results with proper instructions given to the patient.
References:
Zimmer B, Nischwitz D. Therapeutic changes in the occlusal plane inclination using intermaxillary elastics. J Orofac Orthop. 2012 Sep;73(5):377-86. doi: 10.1007/s00056-012-0100-5. Epub 2012 Sep 7. PMID: 22955576.
Davidovitch M, Konstantarakis E, Athanasios V, Sella-Tunis T. Effects of Class II elastics during growth on the functional occlusal plane according to skeletal pattern and extraction vs nonextraction. Angle Orthod. 2023 Jan 1;93(1):19-25. doi: 10.2319/051521-381.1. PMID: 34929025; PMCID: PMC9797140.
Ciavarella D, Fanelli C, Suriano C, Cazzolla AP, Campobasso A, Guida L, Laurenziello M, Illuzzi G, Tepedino M. Occlusal Plane Modification in Clear Aligners Treatment: Three Dimensional Retrospective Longitudinal Study. Dent J (Basel). 2022 Dec 27;11(1):8. doi: 10.3390/dj11010008. PMID: 36661545; PMCID: PMC9857834.
