Innova Magazine by 3M
Orthodontic science and practice excellence
  • Orthodontic Retreatment in Adult Patient with 3M™ Clarity ™ Advanced Ceramic Brackets

    • Introduction

      There is today a great demand for orthodontic treatment among adults. This demand has increased due to a greater awareness of the importance of adequate oral health, to an increase of esthetics demands in society, to greater access of information about treatment, and to technological advances in the area of orthodontics¹. The majority of adults seeking treatment demand an appliance that is minimally noticeable, but effective in correcting their malocclusion². The desire is to treat their teeth without compromising their esthetics during treatment.

    • Diagnosis

      A 25-year-old woman sought consultation with the main complaint of slight crowding in the front teeth. Despite previous orthodontic treatment, she felt dissatisfied with the results.

    Image 1. Initial extraoral photographs.

    • Image 2. Initial intraoral photographs.

      The patient presented a dolychofacial biotype (FMA 31.5 °, SN-MP 42.5 °), and a skeletal Class I relationship (ANB 3 °). On the right side she presented a Class II molar relationship and a slight Class III canine relationship, due to a previous extraction of the upper right second premolar for orthodontic purposes. On the left side, she presented a slight Class III molar and Class I canine relationship. The overjet was 1.5 mm and the overbite was 5%. The upper midline was deviated 1.5 mm to the right and the lower midline coincided with the facial midline. She had a slightly convex profile with adequate lip seal. The panoramic radiograph showed an adequate level of alveolar bone process and confirmed the absence of the second upper right premolar and the upper and lower third molars.

    • Image 3. Initial lateral cephalometric and panoramic x-rays.

      Treatment plan

      3M™ Clarity™ Advanced Ceramic Brackets .022” slot MBT™ System and .022 slot 3M™ Victory Series™ Buccal Tubes were bonded and interconnected with lacebacks. Extraction of the upper left second premolar was performed.

    • Image 4. Treatment progress with upper and lower .016 NiTi heat activated arches.

      The sequence of archwires used was .016 NiTi HA for alignment, .017x.025 NiTi HA and .019x.025 NiTi HA for leveling, and .019x.025 S.S. to complete leveling and to start space closure. The space closure was performed by sliding mechanics with the use of 12 mm NiTi coil spring.

    Hero-image5

    • Class III elastics were used on both sides to obtain Class I molar and canine relationship and to improve the overjet and overbite. 

    Image 6. Final extraoral photographs.

    • Image 7. Final intraoral photographs.

      In the retention phase, a wraparound Hawley retainer was prescribed in the upper arch and in the lower arch a fixed retainer from 3 to 3 was bonded. The total treatment time was 26 months.

    Hero-image8

    • Image 9. Final lateral cephalometric and panoramic x-rays.

      The total treatment time was 26 months. 

    Table 1.  Initial and final cephalometric values.

    • Discussion

      The prevalence of malocclusion in adults is equal or greater than in children or adolescents³. It is possible to provide extensive and successful treatment to adult patients, they usually cooperate throughout treatment, and are careful with the appliances and with good oral hygiene. Adult patients want to be well informed about the progress of their treatment and usually do not miss their appointments. The decision to pursue treatment is on their own, based on their desire to improve their esthetics, functionality and self-esteem⁴. Adults are less tolerant of discomfort and of difficulties with speaking or eating. Therefore, clinicians need to have the capacity and experience to address these issues and provide solutions⁵.

      Conventional fixed appliances are still the most frequent treatment method used by orthodontists, due to the efficiency in controlling orthodontic tooth movement and the ability to correct malocclusions with a higher level of complexity. Therefore, the combination of esthetics – provided by 3M™ Clarity™ Advanced Ceramic Brackets – and effective mechanics – provided by the 3M™ MBT™ Appliance System – provides the patient the esthetic treatment desired and provides the doctor the control needed to achieve good results.

    • Bibliography

      1. Souza, R. A. D., Oliveira, A. F. D., Pinheiro, S. M. S., Cardoso, J. P., & Magnani, M. B. B. D. A. (2013). Expectations of orthodontic treatment in adults: the conduct in orthodontist/patient relationship. Dental press journal of orthodontics, 18(2), 88-94.

      2. Boyd, Robert L.; Miller, R. J.; Vlaskalic, Vicki. The Invisalign system in adult orthodontics: mild crowding and space closure cases. Journal of Clinical Orthodontics, v. 34, n. 4, p. 203-212, 2000.

      3. Buttke, Thomas M.; Proffit, William R. Referring adult patients for orthodontic treatment. The Journal of the American Dental Association, 1999, 130.1: 73-79.

      4. Fastlicht, J. (1982). Adult orthodontics. Journal of clinical orthodontics: JCO, 16(9), 606.

      5. Wu, Abby KY, et al. A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances. The European Journal of Orthodontics, 2010, 32.4: 403-407.


    • Oscar Mario Antelo, DDS, MS

      Oscar Mario Antelo, DDS, MS

      Dr. Oscar Mario Antelo received his degree in dentistry from the Christian University of Bolivia in 2001, received his Master’s degree in Orthodontics from the Intercontinental University in Mexico in 2005, and will finish his Ph.D. in Orthodontics and Dentofacial Orthopedics at the Pontifical Catholic University of Paraná in Brazil. Dr. Antelo is a professor of the Specialty in Orthodontics at the Catholic University of Santa Cruz de La Sierra - Bolivia, is a visiting professor in the Specialty in Orthodontics of the Pontifical Catholic University of Paraná in Curitiba - Brazil, is a certified member of the group of professors of the MBT Philosophy and is author of several publications in international scientific journals of high impact in the area of orthodontics.


     

     

     

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