Six Month Smiles Case Studies

To help you decide if Six Month Smiles is for you, Sacramento Dentistry is happy to present stories of actual dental patients and the treatment they received.

Patient’s Chief Complaint: A straighter smile without Interproximal Reduction

A Case Study by Dr. Noel Ananthan

This is Elvia, a case that I presented during the last Advanced Level Webinar and which I want to share with you. Elvia is a 28-year old executive assistant whose chief complaint was that she wanted a straighter smile. The key elements in the initial assessment were the impacted upper left canine and the upper left lateral incisor in cross-bite. Because we determined through an oral surgery consultation that the canine was favorably situated for exposure and alignment, the treatment plan appeared to be a textbook approach: space creation and alignment and rounding with the addition of bringing the canine down.

Elvia before

However during the consultation/work-up process, Elvia decided that she wanted absolutely no interproximal reduction (reducing the size of specific teeth by polishing away small portions of enamel, also called IPR) performed as a part of her treatment. Despite my best efforts to educate her that it was safe and extremely conservative, Elvia remained adamant that we carry out treatment without IPR. Even after I told her that the only alternative was an extraction in each arch, she still did not want IPR to be performed.

I chose a staged approach to deal with this case. The first stage was overall alignment and space closure, which took about 3 months. This consisted of:

  • extracting the upper left first bicuspid and lower right central incisor at the braces on appointment;
  • placement of second molar biteguards to open the bite to allow the upper left lateral incisor to clear the cross-bite;
  • lower arch powerchain to close the extraction space; and
  • simply ensuring proper wire engagement to correct rotations and allow the brackets and wires to align the teeth.

This first stage allowed me to stabilize the arches, and most importantly the teeth adjacent to the impacted canine, with long ties for anchorage before moving on to stage two which was exposing and engaging the upper left canine. Stage 2 involved engaging the arch wire, powerchain and interarch elastics to guide and help movement. Anchorage is a key fundamental concept in orthodontics and learning to both respect and use it makes treatment much more efficient.

Elvia before

Because of the pre-treatment rotations in Elvia’s right anterior area, a further potential problem that we faced (and had warned the patient of) was the shifting of the upper midline as alignment progressed. Unfortunately, there was no easy solution for this so we did see the midline shift slightly to the left, although Elvia was perfectly happy with the end result. I addressed a small black triangle between the lower left central and lower right lateral incisors which remained from the space closure (and also a potential problem with ‘crossed’ upper incisors) through simple bonding. Elvia was ecstatic with her new smile. She now feels that it better represents how not only she sees herself, but also how she would like others to see her.

Elvia after

I hope that this case has illustrated that Six Month Smiles uses sound orthodontic principles to achieve great results, even with complications such as impacted teeth. In hindsight, if I could change anything with this case, I would have taken greater care to manage the presentation of information to Elvia to have made IPR acceptable to her. But that is my dentists’ bias coming through. We always have to respect that there is a real person attached to the teeth that we treat which makes the chief complaint nature of Six Month Smiles an even greater service and value to our patients.

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