I am Zhang Jun, director of the Department of Orthodontics of a third-class public stomatological hospital, and have been in the industry for 31 years, and have completed 5,000+ aesthetic cases
Many small partners have seen my previous cases, contacted me to come up with a detailed explanation of orthodontic cases, to meet everyone's requirements, sorted out my cases, involving a lot of professional content, due to the length of the problem, I will pick some key points to talk about.
If you have any questions or dental problems, you can comment or private message consultation
This girl was a patient I was treating at the provincial hospital and ended up removing braces in my private clinic.
The girl complained: the mouth is protruding, the teeth are very untidy, the tiger teeth are not beautiful when smiling, and there is a phenomenon of opening the lips and exposing the teeth.
After oral examination: the dentition belonging to the Ann's class is crowded, the molars are neutral, but the cuspid teeth are far-middle, the arch morphology is not very good, it is a cuspid arch, the second class of bony wrong jaw, the angle of the mandibular plane is even angle, and the condyle morphology is slightly asymmetrical.
I have been in the orthodontic industry for more than thirty years, and in the clinic I often find that patients with severe crowding, or patients with malocclusion deformity, will have asymmetrical condylar form.
But fortunately, this girl has no obvious joint symptoms, her lateral appearance is a very prominent face shape, the corner of the nose and lips is relatively small, the condyle muscles are also relatively tense, the jaw is slightly retracted, but her 1/3 height under the face is basically OK.
We measured her maxillary congestion: 8mm Jaw congestion: up to 9mm, which is heavy congestion.
In addition, her coverage also reached 7mm, which is a deep overlay of three types, her occlusal relationship and two jaws and fangs are remote, and the bolton specific gravity analysis is basically coordinated. We also examined her jaw ascending branch and bilateral condyle morphology were slightly asymmetrical, but ct detected no significant changes in active absorption, no missing teeth, no significant root abnormalities, and normal airways.
Let's take a look at one of her faces, when she closes her mouth, she can see that it is a little laborious, in the relaxed state, she is opening her lips and teeth, and you can see that the two small tiger teeth on one side are very obvious, and the midline is also skewed.
The situation in her mouth, her front teeth because of the irregularity of tooth volume and bone mass, the fan-shaped unfolding, is already protruding to the outside of the root alveoli, the fangs are twisted, the crowding is very serious, up and down belong to the fang arch, the width of the dental arch is not coordinated, and the narrowness of the dental arch will also cause her to smile very unsightly.
The image below is a positioning probe of his skull and a full-jaw curved tomography, which shows a rough morphology of the condyle and a relationship between the skull, side caps, soft tissues, and teeth.
This is a description of our pictorial measurements, a few simple data records, her anb angle is 4.8 degrees, mild bony class II patients, her mandibular plane angle is 33 degrees, is average angle, her jaw morphology is also better, basically close to the flat rectangle.
The data measured by the cephaloid, the more abnormal is this anb angle, we diagnosed that she belongs to an Ann's class, skeletal class II, deep covering deep coverage of the dentition crowded, there is a loss of shape and irregularity in the upper and lower jaws. We felt that her loss of shape was out of tune, and that the degree of the maxillary protrusion might be a factor that occupied more.
In order to achieve the desired effect of the patient, we comprehensively analyzed the patient's mouth and face and considered the design from three directions:
1, horizontal goal: we mainly expand the bow, the expansion of the bow can not only provide gaps, but also improve the shape of the dental arch, but also make the girl smile when the cheek porch becomes smaller and narrower.
2. Loss to the target: adductor anterior teeth, adjust the midline, so that the relationship between the fangs reaches a category.
3, vertical target: because considering her face height, 1/3 of the height under the face is still appropriate, so we solve her deep overlay, mainly to lower the front teeth, appropriate can raise some of the double fangs, maintain her a vertical height.
Her bolton ratio is mildly uncoordinated, and her bolton ratio can be coordinated by deglazing the collar of her front teeth, allowing her fangs to achieve a better midline relationship.
After considering the above considerations, I designed three options for the girl:
Scheme 1: Use the Invisalign Appliance to remove the four first double cuspid teeth, beat the nails, use the strong support resistance, fully adductor anterior teeth, and improve the lateral convexity. Laterally, we mainly expand the arch, which can provide gap, improve the shape of the dental arch, and make the girl's cheek porch smaller and narrower when she smiles.
Scheme two: do not extract teeth orthodontic program, extract wisdom teeth, play anti-nail to do molars far away, expand the arch, while cooperating with a large number of collar to glaze, this scheme is not as good as the extraction of four teeth to have a better effect.
Option three: Because the girl is very resistant to playing the nail, so under the premise of removing the first pair of fangs, do not use the support resistance, try to choose non-invasive or minimally invasive ways to solve the problem of adduction of her front teeth, that is, frog jump adduction (the following will explain what is frog jump adduction).
After carefully understanding the three options, the girl finally chose the third option after comprehensive consideration.
The frog jumping adduction front teeth mentioned above, what is the frog jumping style? The so-called frog jumping style is an adduction of the front teeth, the fangs and four front teeth are opened, one-third, one-third adduction, so as to maximize the guarantee that the molars will not move forward. Therefore, the steps for correction are slightly more.
Considering that the girl's periodontal situation is OK, and the urgency of correction is relatively large, I think his compliance is also very good. Therefore, we have adopted a weekly throwing rhythm, that is, each pair of braces is worn for one week, a total of 83 pairs, 53 weeks a year, and it only takes one and a half years to wear it.
This is a situation at the end of her first week of wearing, correcting some of the phenomenon of the middle girl.1
What is unwinding? That is to say, when the back tooth is pulled out and closed, there is a tilt, the lateral incisor is too much on the tongue side, and the torque of some teeth is insufficient, resulting in the front teeth showing a disengagement.
So in order to avoid delaying the treatment time by restarting, we added a sticker on the side of the tongue to her, opened the window on the braces, used a small leather ring of 16 inches, let her clip her tongue and tape rings, and finally pulled the teeth into the braces.
Let the derailed teeth successfully fall into the orbit, which is also a small secret for us, a small trick. Let individual derailed teeth re-enter the direction we continue to design.
You can see her corrected skull positioning positioning probe and full curved tomography, the lateral view can see that her extrusion has improved significantly, the condylar muscle tension has also greatly eased a lot, you can see that the anb before the treatment is 4.5, after the treatment becomes 3.8, the angle of the mandibular plane is also changed from 33 degrees to 32.5 degrees, the angle of the front teeth of the upper jaw is also changed accordingly, although the degree of change is not particularly large, but you can see that her appearance is softer a lot, and the abruptness has also improved significantly.
This is the superposition we made the blue is before the treatment, the red is after the treatment, the change is still quite large.
Finally, to show you a face before and after the correction, the girl feels that her lips are easy to close, the smile line is also very good, and her upper lip and teeth are very matched, the whole person's temperament is completely different, the face shape has undergone a huge change, the whole tooth before and after "refreshed." ”
Head-to-head comparison
A positive smile contrasts
The side smile contrasts
In this case, we did not use implant support, just used g6 attachment and smart stage program, the most important thing is that we designed a frog jumping adduction, support resistance control is very good, in the middle of treatment, the patient temporarily appears some midline irregularities, molar bite is not good, the corresponding strategy should be to change the traction mode in time, the braces in the back tooth area are not fit enough, let the patient eat with biting gum, and even wear braces to eat, sometimes it is necessary to appropriately increase the interval between wearing braces, in general, the correction is still very smooth, The girl was also very satisfied with the effect of the treatment.
The above is a detailed explanation of the invisal beauty to solve the mouth protrusion + severe crowded orthodontic case, if you have read some questions about the teeth, you can come to me for consultation, I hope to help you.