Case Summary
My patient felt she had missed out on orthodontics as a teenager and presented with severe crowding. It was her dream to have a confident smile.
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 PHOTOGRAPHS: EXTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: EXTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: EXTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: EXTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL | 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 1/4 |
| Canine Relationship | Right Class 1, Left Class 3 1/4 |
| Crossbite | Yes, UR2 and UL2/LL2, LL3 |
| 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" |
KEY STAGES IN TREATMENT PROGRESS
Plan
Upper and lower fixed appliances
Extraction all 1st premolars
Upper Nance appliance and Lower Lingual Arch. High anchorage demands due to inclination of canines.
Upper and lower fixed retainers, removable retainers
Review Retainers
Approach
Bond up. Minimal engagement of 012 Niti archwire to upper and lower incisors to prevent proclination of the incisors. Lace back 1st molars and 2nd premolars each quadrant. Retraction of canines with powerchain from 2nd premolars. Upper Nance and lower Lingual Arch.
Once the canines were sufficiently retracted, the upper and lower incisors were ligated into the brackets.
The upper Nance and Lower Lingual Arch were removed once the case moved into 19 x 25 Niti and the lower centreline had been established.
MID-TREATMENT PHOTOGRAPHS:
MID-TREATMENT PHOTOGRAPHS: BOND UP 
MID-TREATMENT PHOTOGRAPHS: BOND UP 
MID-TREATMENT PHOTOGRAPHS: BOND UP 
MID-TREATMENT PHOTOGRAPHS: BOND UP 
MID-TREATMENT PHOTOGRAPHS: BOND UP 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: INTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: EXTRA-ORAL 
POST-TREATMENT PHOTOGRAPHS: EXTRA-ORAL Wires used
012 Niti
016 Niti
20×20 Niti
19×25 Niti
19×25 SS
Conclusion
The IAS advanced course was the best course I have completed. It gave me the ability to treat a whole range of orthodontic cases that previously I would have referred. This case is just one example of that. I would encourage anyone who has had some experience with fixed braces to join this pathway, you will not regret it. The mentoring is excellent and you will feel confident that you have the support and advice both during and after the course. That is so important to us GDP’s..to make us feel safe, plus you’ll make great friends along the way.
