the tweed profile - The Charles H. Tweed International Foundation

There was an improper prosthesis on the maxillary incisors
and generalized periodontitis. It seems that the prosthesis
was placed on the maxillary incisors to conceal the spacing.
The spacing was caused by small tooth widths and large
alveolar bone dimension. Before the orthodontic treatment,
the removal of the improper prosthesis and flap surgeries for
the generalized periodontitis were necessary. The improper
prosthesis was replaced with four separate provisional
restorations prior to treatment.
Generalized periodontitis was evident, especially, in the
mandibular right lateral incisor area and in both mandibular
molar areas. Also, there are mandibular third molars. The
cephalometric analysis findings were: FMIA 38°, FMA 33°,
IMPA 109°, SNA 85°, SNB 77°, ANB 8°, AO-BO 5mm,
occlusal Plane 13°, Z angle 46°, upper lip 10mm, total chin
9mm, posterior facial height 42mm, anterior facial height
69mm and Post/Ant facial height index .61. The cranial
facial difficulty was 138, while the total space difficulty was
20.1. Hence, the total difficulty index was 158.1. In addition,
the total dentition space difficulty was 21.6. For this patient,
most of the problems were in the anterior area.
TREATMENT PLAN
What can we do for this adult patient? As orthodontists, we
must consider esthetics as well as functionality. However,
in many instances, we are forced to make compromises
due to various constraints: age, time, financial aspects,
oral and general health conditions, patient’s expectations,
feasibility, etc. In addition, we must also consider restorative
requirements, periodontal condition, prosthetic requirements,
and orthodontic problems. A careful examination of all these
conditions and requirements, before and after the orthodontic
treatment, is extremely important since they heavily influence
the retention.
With all the factors considered, the following treatment plan
was formulated: removal of the prosthesis from the maxillary
anterior teeth, flap surgeries in the whole dentition, extraction
of the four first premolars and of the three third molars,
application of high pull J-hooks and elastics for maximum
anchorage, periodic plaque control, a new prosthesis,
retainers, and bleaching. The high pull J-hooks had to be
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