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Orthodontic
Case Studies
Paul Downes BDS MGDS DGDP LDS
www.khdp.co.uk
www.social6braces.com
1
Whitstable Kent
Child patients
NHS versus Private treatment
I have an orthodontic contract that enables me to treat a
set number of patients on the NHS every year.
Child patients can be treated on a private basis if the
problem is too mild to qualify for treatment on the NHS.
Private patients have the option of ‘clear’ fixed braces
and to be seen outside of our normal 10.00am - 3.00pm
‘braces’ slot.
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An example of early treatment
For most child patients, the best time to treat them is
between the ages of 10 - 15 years.
There are however occasions when it is desirable to treat
children at a much earlier age. For example, this patient
was 7 years of age when I placed a simple fixed brace to
derotate the severely rotated upper right cenral incisor and
correct the cross-bite on both incisors.
3
a
How fixed braces work
Here you can see that I placed upper and lower fixed
braces (‘train-tracks’) using metal brackets stuck onto
each tooth. Coloured elastic rings hold the initial very thin
wire in place. This special wire has a ‘memory’ and will
try to move back into its original curved shape, taking the
misplaced tooth with it as it moves. As the teeth straighten,
larger wires are placed which control the fine movements.
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a
The growing child
While children are still growing, we have the opportunity
of using braces not just to straighten the teeth, but also
to modify the growth and development of the jaws. In this
particular patient, who had a very narrow upper arch, I
was able to expand the arch using a combination of fixed
appliances.
5
a
Cosmetic or functional treatment?
This child’s main concern was his upper rotated incisors
(cosmetic problem). However, he also had a very deep
overbite (the degree to which the upper front teeth overlap
the lower front teeth). This deep overbite was causing
trauma to the gums behind his upper front teeth (functional
problem). His course of fixed braces, which took less than
the normal 18-24 months, corrected both problems at
once.
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Adult patients
Conventional adult orthodontic treatment
I treat many private adult patients with conventional fixed
braces. These are mainly cases where the patient has
moderate to severe crowding.
Social 6 adult orthodontic treatment
Social 6 braces are a compromise orthodontic treatment
that treats the 6 front teeth that show the most (hence the
term ‘Social 6’).
Since this is often the main and only concern for many
adult patients, this has become a very popular way to get
beautifully straight front teeth.
Taking anywhere from 3-6 months, Social 6 braces are
also very fast. They are ideal for correcting rotations,
spacing and mild to moderate crowding. Like any form of
orthodontic treatment, retention (holding the teeth in their
new position) is mandatory.
There is no age restriction for adult orthodontics.
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A typical upper Social 6 case
This lady’s main concern was her crooked and rotated
upper lateral incisors. Treatment consisted of a series of
Clear Aligners followed by a fixed and removable retainer.
Total treatment time was 16 weeks.
8
The Inman Aligner
The Inman Aligner is one of the 4 types of Social 6 brace
that I use (the others types being Clear Aligners, Fixed
braces and Upper Removable Acrylic appliance).
This lady was treated with an upper Inman Aligner in 4
months. In common with all Social 6 braces, the end result
is a nice rounded arch form for the front teeth.
Notice the fixed retainer which holds the teeth in their new
position. Retention is for life (or for as long as the patient
wants to guarantee that the teeth won’t move). We monitor
the retention every 3 months for one year after treatment.
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The ABC of modern cosmetic treatment
A = Alignment
This patient wore a simple removable appliance to
derotate the upper right central incisor
B = Bleaching
This was followed by teeth whitening
C = Composite bonding
Then I built up the worn incisal edges with composite
(white filling material) to restore their natural shape
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Social 6 braces to correct spacing
His main concern was the wide gaps between his fanned
upper incisors. He also had a deep overbite (with the lower
teeth almost biting against his palate) which prevented us
from simply pulling the upper teeth together.
Treatment took 6 months and started with a removable
upper acrylic appliance to reduce the deep overbite. This
was followed by upper and lower ‘clear’ fixed braces (with
brackets on only the front 6 teeth).
11
Instant orthodontics
I don’t treat all my patients with braces!
This delightful young lady didn’t like the look of her two
front teeth. Her treatment started with teeth whitening
followed by composite bonding to close the gap between
her two front teeth. We also smoothed the incisal edges of
these teeth to improve the overall appearance.
Treatment time was 16 days for the teeth whitening and
one 90 minute appoinmtent for the composite bonding.
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