CASE REPORT
CASE REPORT
Dental intrusion remains a common challenge in orthodontic treatment, but can significantly improve esthetics and function for a patient when achieved. This case demonstrates the use of the first true full-expression, passive self-ligating bracket system, Damon Ultima, in conjunction with the award-winning VectorTAS Temporary Anchorage System, to successfully treat a 15-year-old patient in permanent dentition with general dissatisfaction regarding her gummy smile. This case report details challenges that can arise with the use of auxiliaries and how to update the treatment plan to intervene when unexpected problems arise.
Dr. Kristoffer Aavatsmark*, Norway
Kristoffer Aavatsmark earned his dental degree at the University of Bergen, Norway 2007. He then worked as a general practitioner for two years before attending the Orthodontics postgraduate program in Oslo, Norway full time from 2009-2012. Dr. Aavatsmark currently works in a little town where his practice recently became a part of “Oris Dental” group. He has treated thousands of patients with the Damon Q and Damon Ultima system. He also uses TADS, Spark and a wider variety of tools for orthodontic treatments. Dr. Aavatsmark has a passion for ortho and shares his cases on Instagram under the user “kjeveortopedstjordal”.
15-year old patient presented with the following chief complaint: “I don’t like my smile.”
The extraoral exam revealed a harmoniously proportioned and symmetrical face with a straight profile and lip competence. The smile analysis was summarized with insufficient incisal display due to lower lip coverage, excess gingival display with a thinning upper lip, and wide buccal corridors which enhanced the display of misaligned upper canines.
The intraoral exam revealed sagittal, transverse and vertical malocclusions with a Bolton discrepancy of teeth 12 and 25. The patient had bilateral class II malocclusion with a moderately increased overjet and overbite, a moderate curve of Spee and narrow arches with minor crowding. The dental midlines were incongruent and lingual crown torque was the dominant tooth inclination. There were no crossbites, but teeth 13, 21 and 41 were rotated.
The clinical findings were confirmed by radiographic analysis with vertical measurements within normal range and the ANB angle equal to 5 degrees.
The treatment goals were to correct the malocclusion and enhance esthetics during smiling using the following treatment protocol:
The treatment plan was followed as outlined with close monitoring of the anterior intrusion and a few modifications as described below:
Archwires when intrusion was began: 18×275 CuNiT both arches.
Intrusion was performed during 4 months with powerchains and Vector TAS 6mm (purple).
12-22 were steelligated.
For stabilizing when using cl 2 elastics, steel ligatures were used from tads to the archwire.
A challenge was detected, and the treatment plan was modified accordingly; the right side TAD failed, resulting in canting of the occlusal plane. The was corrected by placing a new 10mm miniscrew (blue).
The treatment goals were fully met despite unexpected challenges along the way. In the final outcome, the overjet, overbite and gummy smile were corrected with adequate incisal display and reduction of the buccal corridors. Full class correction was achieved, midlines were made coincident, and rotations and crowding were resolved, resulting in a harmonious, esthetic smile with functional occlusion.
This case reports demonstrates successful treatment of a challenging malocclusion through thorough planning, correct interventions and the most innovative dental equipment and technology. Combining the appropriate Damon Ultima prescription with timely treatment monitoring and the proper mechanics and auxiliaries to support the best outcomes from the bracket system, Dr Aavatsmark was able to deliver dynamic treatment that transformed this patient’s smile and resulted in ideal function and esthetics.
* Dr. Kristoffer Aavatsmark is a paid consultant for Ormco. The opinions expressed are those of Dr. Kristoffer Aavatsmark. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment intreating their patients.
