the tweed profile - The Charles H. Tweed International Foundation

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CLINICAL CROWN LENGTH AND GINGIVAL OUTLINE, THEIR EFFECT ON THE ESTHETIC APPEARANCE OF ANTERIOR TEETH SERGIO A. CARDIEL RÍOS MAGALI CARDIEL RÍOS MORELIA, MICHOACÁN, MÉXICO Many times missing or fractured anterior teeth are clinical situations that the orthodontist must consider. It is often difficult to produce a successful esthetic result when these conditions exist. The irregular appearance of the anterior teeth can be improved by altering the clinical crown lengths and gingival contours of the affected teeth during orthodontic treatment. The following case report illustrates Tweed-Merrifield directional forces therapy in which clinical crown lengths of the anterior teeth was intentionally modified and periodontal procedures were followed to produce a more esthetic result. Fig 1 CASE DESCRIPTION The case report of an 18- year old Mexican patient is presented. He had a Class I malocclusion with a negative medical history. The patient´s complaint was that he exhibited unesthetic dental appearance when smiling. There was good facial balance (Fig 1). Intraorally, there was a moderately deep overbite, dental fractures, very severe crowding, gingival margins that were not level and midline discrepancies. Occlusal views showed considerable dental crowding, rotations and Bolton discrepancies (Fig 2). The panoramic radiograph showed the complete dentition and no signs of pathology (Fig 3). Fig 2 47 Fig 3
Cephalometrically, there was a good skeletal pattern, a good maxillo-mandibular relationship and angulations of teeth. Occlusal plane and Z angle were ideal (Fig 4). DIAGNOSIS AND TREATMENT PLANNING The cranio-facial analysis revealed no skeletal problem and Merrifield´s total space analysis indicated space requirements in the anterior and posterior area. The total difficulty score was only 29. Orthodontic treatment was planned. The extraction of maxillary and mandibular first premolars and all third molars was indicated. This patient’s malocclusion correction serves as a good example of how Tweed-Merrifield directional force technology can help the clinician achieve a good result regardless of the space severity. However, it is important to summarize some issues that were relevant during the correction of this treatment: a. Maintenance of arch form and archwire coor- dination b. The use of proper directional forces c. Second order bends – good and efficient an- chorage preparation d. Leveling and reshaping anterior teeth Fig 4 Fig 5 Periodontal concerns were also considered. The periodontist recontoured both gingival and alveolar bone margins to a more ideal level after the anterior teeth were leveled and Bolton discrepancies eliminated. Since the patient presented with severe anterior crowding, the periodontist also did a supracrestal fiberotomy from premolar to premolar in both arches three months prior to the removal of orthodontic appliances. The patient was periodically examined during orthodontic treatment to evaluate oral hygiene and tissue conditions (Figs 5 and 6). Figure 7 shows changes in the gingival outline of the anterior teeth before and after treatment. Fig 6 RESULTS The face shows harmony and balance. The smile line and buccal corridors have improved as has the noselip-chin spatial relationship (Fig 8). Teeth and gingiva are healthy and esthetic. Good “architecture” of the gingival complex is evident (Fig 9). Fig 7 A Class I occlusion was maintained along with proper canine guidance. The maxillary arch has harmony in shape and proportion of the teeth because the Bolton discrepancy was eliminated. The mandibular arch shows nice dental alignment. The occlusal plane was controlled while overbite and overjet were overcor- Fig 8 48
Page 1 and 2: THE TWEED PROFILE PUBLISHED BY THE
Page 3: CONTENTS 2 ORTHODONTICS IN THE AGE
Page 6 and 7: FACIAL ESTHETICS - A VALID TREATMEN
Page 8 and 9: the final result. Communication wit
Page 10 and 11: VERTICAL CONTROL FOR THE CLASS II P
Page 12 and 13: The following records are those of
Page 14 and 15: This patient has crowding and is sl
Page 16 and 17: She was treated with Tweed-Merrifie
Page 18 and 19: This will Increase the Amount of In
Page 22 and 23: A .020 x .025 stainless steel T-loo
Page 24 and 25: for the other half (N=45) included
Page 26 and 27: tooth alignment. Long term stabilit
Page 28 and 29: RME ON PERMANENT VS RME ON DECIDUOU
Page 30 and 31: The “New REP” was retained for
Page 32 and 33: • Intercanine diameter: measured
Page 34 and 35: The second CBCT was repeated 10 mon
Page 36 and 37: 30. Ricketts RM, Roth RH, Chaconas
Page 38 and 39: DISCUSSION The described clinical a
Page 40 and 41: tion effect was created by the shif
Page 42 and 43: ceptable and favored by the Japanes
Page 45 and 46: CORRECTION OF ADULT SKELETAL CLASS
Page 47 and 48: applied for 10 to 12 hours a day an
Page 49: TREATMENT RESULT The patient was tr
Page 53 and 54: REFERENCES 1. Zachrisson B, Alnaes
Page 55 and 56: The panoramic X-ray (Fig 3) shows n
Page 57 and 58: Fig 15 Fig 18 Fig 16 Fig 19 SUMMARY
Page 59 and 60: the rather short anterior-posterior
Page 61: Figure16 correction which, in turn,

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