The First Archwire In Orthodontic Treatment

The first step in most Orthodontic treatments is alignment. Even in a case of Class I bimax, the brackets need to be aligned before starting retraction. Alignment is a primary criteria of a perfect Smile.
The primary determinant of the choice of the first archwire in Orthodontic treatment is the severity of crowding. I would usually recommend starting a case with a round 0.014 Niti. However, a 0.012 Niti can be used in the following cases:

Severe Crowding is an indication of starting with 0.012 Niti

1. A case of very severe crowding can be started with a low force archwire as the degree of deflection of the archwire will be severe. The flip side is that there are increased risks of wire breakage due to the strain on them.
2. A very sensitive child or a very high profile patient, in which you want to slowly initiate the treatment without causing a lot of discomfort in the first few weeks would be another indication in my practice. This is an important practice management fundamental.

Discussion : As we move towards regimes of gentler, biologically adaptive force regimes, starting with 0.012 Niti will soon become a rule rather than an exception.

Fracture of an Upper Incisor Restoration

A crescent fracture of upper left central incisor crown

Occlusion is a potent factor in successfully restoring anterior restorations also. If the overjet is reduced or the palatal contour of a restoration is excessive then the anterior guidance is compromised. Excessive pressure can be generated on a single restoration which results in an abfraction type of fracture of the restoration.

Please note that this excess contour is not seen in MIP and articulating papers will not detect it in MIP. It will become obvious only in protrusive movements when only this overcontoured tooth will make contact and the other upper incisors will not be in contact with the lowers in protrusive.

If all the upper anteriors are restored with excessive contour then the mandible will be pushed backwards in the fossa and this will effect the disc and TMJ.

Moral - Functional Occlusion is important in the final restoration.

Single Tooth Cross-bite

Clinically, a single tooth crossbite is described by many Orthodontists as a true Orthodontic emergency and should be attended to as and when detected. The option that i normally use is fixed brackets on the upper anteriors extending upto the deciduous 2nd molar. A glass ionomer bite platform may or may not be necessary if the bracket is not obstructed by the opposing incisors. Treatment time is usually upto a few months only. Full treatment may be required after complete eruption of the permanent dentition. This is an interceptive Orthodontic procedure.

Single Tooth Anterior Crossbite

Orthotrain stall at Famdent Show from 7 to 9-June 2013

It was a memorable event attended by a lot of Dentists and interns at the exhibition centre at Goregaon. The picture shows the brochures of details of all courses offered under the umbrella of Orthotrain.