A 38- year-old patient had severe lower crowding, a crossbite on the right side, a missing upper right canine, front teeth with shortened incisal edges due to wear and attrition, a moderate periodontal problem (gum disease), uneven gum lines, and an upper midline deviated 3 mm to the patient’s right (due to the missing canine).
This case was a complex case due to all factors described above. The approach had to be multidisciplinary, meaning that multiple professionals had to discuss and treat it. This case was treated by a periodontist (gum specialist), an orthodontist and an aesthetic specialist. (In the next step he will also wear implants and the crowns on some teeth must be replaced, but this part is not orthodontia and I will not put it here.)
After all professionals involved studied the case, we decided to turn the upper premolar into a canine, to provide better aesthetics to the front part of the teeth. In terms of orthodontia, it was decided to remove a lower incisor due to the severe crowding and very delicate gums that the patient had. In this case, we were unable to do very much expansion, and so we were not able to gain much space this way.
The image shows that the right side is missing a canine.
It was important to take into account that the premolar was narrower than the canine. This meant that it had to be left rotated about 30º so that it occupied a greater width and, when reconstructed, would be similar in width to the canine on the other side. Furthermore, it had to be intruded (pushed up) so that its gum line was as high as that of the other canine. Not doing this would leave the aesthetic specialist unable to achieve proper symmetry in terms of gum lines and size.
After 22 months of treatment with self-ligating brackets, this result was achieved.
It can be seen that the teeth were straightened with a nice arch shape, a lower incisor was removed and the crossbite on the patient’s right side was resolved. The upper right first premolar was rotated about 30º until it occupied the appropriate width and intruded so that it was as high as the canine on the left side.
In this phase of treatment the patient proceeded to aesthetic rehabilitation of his teeth with the aesthetic specialist (Dr Lorena Herrero).
The end result was impressive:
detail of premolar and its reconstruction in all phases
Intra-oral photos of the end result.
For further information please contact us by telephone (+34) 93 832 72 81.