Fixed Anterior Alignment – Case Study: MK

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, and this case won the Best Advanced Case at IAS Academy’s 2018 international symposium in London. This case shows the advantage of a systematic educational pathway and mentorship by an orthodontic specialist giving advice and confidence to the treating dentist—in this case, Prof. Ross Hobson from IAS Academy’s online mentoring forum.

CONTACT INFORMATION

Straight White Teeth London
6 Drayton Green Road,
West Ealing,
London,
W13 8RY

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Case Study: MK

Background

My patient was referred by her friend, who had completed orthodontic treatment with me. Her chief complaint was the gaps between her teeth which she had longed to have closed since her teenage years. The patient’s gaps were hereditary, and I was cautious to plan retention carefully because the tongue is a significant soft tissue aetiological factor.

Pre Treatment
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Assessment

I didn’t have my patient turn fully for the lateral profile photo. The image shows some strains on the neck muscles, and I’ve since learnt to position the patient more favourably. Preop lateral retracted photos were also not properly orientated, and the patient had a higher lip line than the pre-treatment photos depict.

Measurement Result
Skeletal Pattern Class II Mild
FMPA Average
Lower Face Height Average
Facial Asymmetry No
Soft Tissues Details: Competent Lips, low smile line, acute NLA
Teeth Present All teeth present
Incisor Classification Class III
Overjet 1mm
Overbite 0%
Centrelines Upper and lower left by 1.5mm
Displacement on closure No
Molar Relationship Right Class I, Left Class I
Canine Relationship Right Class I, Left Class I
Crossbite No
Spacing/Crowding Upper Arch 8mm, Lower Arch 10mm

Treatment

The patient was very compliant, and her progression was smooth. I warned her before treatment that extractions may be indicated should she slip into reverse overjet. Fortunately, this didn’t happen, and Class III elastics helped to maintain positive overjet.

I am pleased that the Class I canine and molar relationships were maintained.  The initial photos may not have shown the Class I relationship.

A specialist from a previous orthodontic course recommended double fixed retainers in a large diastema case, which drew some discussion on the IAS Forum.

I recently reviewed the patient, and stability has been maintained. On reflection, there is room for marginal improvement on the tip of the upper incisors. I spent some time improving the detailing with repositioning brackets, and I have since identified detailing my wire bending skills as a new learning target.

Mid Treatment
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