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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. 2 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. 4 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. 6 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. 7 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. 9 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 10 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. 12