Fixed Anterior Alignment – Case Study: CW

Fixed Anterior Alignment by Dr Nick Simon

Dr Nick Simon is a former IAS teacher and Mentor. He was a delegate on the first cohort of the Advanced Fixed Course taught by Prof Ross Hobson. My patient felt like she needed orthodontics as a child but had missed out. She presented with severe crowding, which detracted from her smile and left her low on confidence.

CONTACT INFORMATION

The Ealing Dental Practice
6 Drayton Green Road,
West Ealing,
London,
W13 8RY

Website: Click Here

Pre Treatment
Pre Treatment
Pre Treatment
Pre Treatment
Pre Treatment
Pre Treatment
Pre Treatment
Pre Treatment
Measurement Result
Skeletal Pattern Class I
FMPA Average
Lower Face Height Average
Soft Tissues Details: competent lips, acute NLA, average smile line
Teeth Present 8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8, 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7
Incisor Classification Class I
Overjet 4mm UL1
Overbite 40% overlap
Centerlines Coincident upper, Deviated Lower Right by 2mm
Molar Relationship Right Class I, Left Class III
Canine Relationship Right Class 1, Left Class 3 1/4
Crossbite Yes, UR2 and UL2
Crowding Upper Arch "Severe crowding anteriorly, UR3 and UL3 high and buccal.
Posterior teeth generally aligned", Lower Arch "Severe crowding anteriorly, LR3 blocked out of arch buccally and mesially inclined, LR1 mesiolingually rotated
Posterior teeth generally aligned"

Case Planning

I planned to use upper and lower fixed appliances following the extraction of all the first premolars and used upper Nance and lower lingual arch appliances as I knew the inclination of the canines would create high anchorage demands. I felt the patient would need upper and lower retainers and planned to review her retention progress regularly after treatment.

Treatment

Once the canines were sufficiently retracted, I ligated the upper and lower incisors into the bracket slots. The upper Nance and lower lingual Arch were removed once I had run through the complete wire sequence and into 0.019” x 0.025” NiTi wire, and the lower centreline had been established.

At bond-up, the upper and lower incisors were only minimally engaged to prevent them proclining. Lace-backs were applied at each quadrant between the first molars and second premolars. A power chain was used to retract the canines from the laced back second premolars. Upper Nance and lower Lingual Arch appliances were used to provide additional anchorage.

Mid Treatment
Mid Treatment
Mid Treatment
Mid Treatment
Mid Treatment

Outcome

The patient was pleased with her treatment and said it had a positive impact on her day-to-day well-being and confidence. IAS mentors were instrumental in helping me achieve success with this case. 

Post Treatment
Post Treatment
Post Treatment
Post Treatment
Post Treatment
Post Treatment
Post Treatment
Post Treatment