Insights on Case Management 🦷

Question:

Hi everyone! Ok, I feel like I am jumping into the deep end for this case!! Please let me know if I should take this on, or is it physically not possible for this much movement. 66 y.o. male patient, he currently wears a PUD and hates it, he wants to correct the 10 mm OJ, but he also has a 100% deep bite. Hes missing multiple teeth due to extractions, and congenitally missing 12, 22. Is it possible to retract the upper anterior and distalize the 13 and 23 to make space for 12/22 for possible implants or bridges post ortho. I will for sure submit this case to Kelley for help setting it up, but wanted to see first if this can actually be treated? Thank you so much!

Answer:

Case Review: Orthodontic Treatment Strategy and Analysis

This article discusses clinical insights and considerations regarding a specific orthodontic treatment case. The comments reflect a professional assessment of the treatment plan, options, and strategy, particularly in regard to tooth movement and periodontal concerns.

The case was initially reviewed by Ashlyn, whose approach and analysis were acknowledged as thorough. Her recommendation to maintain the current treatment case was agreed upon, as it presents the most viable option given the existing conditions.

A significant concern in this case is the crown-to-root ratio, which is notably poor. This necessitates minimizing significant tooth movements to preserve structural integrity. The proposed strategy involves consolidating space rather than retracting the teeth entirely. The goal is to move the teeth just enough to create an adequate overjet, which would support proper occlusion without causing undue stress on the existing dental structures.

Additionally, mesial movement of the lower arch is recommended to provide necessary space. The positioning, as depicted in the treatment plan, is considered acceptable. However, care must be taken in regard to the intrusion shown, as the patient presents with periodontal disease. It is critical to confirm that the periodontal condition is not active, as any aggressive movement—especially intrusion—could risk the loss of multiple teeth.

In this context, correction of the deep bite beyond what is shown in the initial ClinCheck is not advised. The recommendation is to simply close the space and retract the anterior teeth without attempting to move the canines fully into their ideal position.

Attention was drawn to the pontic used in the canine position, which was described as unsatisfactory in appearance. It was suggested that the pontic be replaced, as Ashlyn also noted. Ideally, two pontics should be used on the patient’s left side, and potentially two on the right, although initially, using one large pontic on the right might suffice.

Anomalies in gingival representation were observed, attributed to the use of the Clearly Select Template. When many teeth are missing, it is generally advised not to utilize this automated template. Instead, cases with multiple missing teeth or significantly worn dentition should be sent directly to a human technician. This avoids the unusual issues that arise from automation, which was the case here.

Once these initial corrections are made, the plan can be sent back for further evaluation. The adjustments outlined represent the starting point for a more refined and effective treatment strategy.