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Gummy Smile Correction Chris Chang. Episode 39. IOC 2020

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Hosted by
Farooq Ahmed

 

Chris Chan describes his favourite positions for TADs, buccal shelf, Ramus TAD, Infrazygomatic and anterior TADs.

 

Buccal shelf TAD: Class 3

  • Buccal shelf TAD in the L6-7 region
  • Whole arch distalisation – en mass retraction lower arch to TAD
    1. Distalises lower arch
    2. Moment: counterclockwise = change occlusal plane
  • Class 2 elastics to lower TAD to prevent upper incisor proclination
  • Self ligation – allows freedom between teeth – similar to MEAW
  • Finite analysis showed CoR at the lower canine region = greater moment

 

Buccal shelf TAD: Scissor bite posterior quadrant

  • Complete scissor bite and over-erupted upper posterior teeth
  • Buccal shelf TAD in the L6-7 region
  • Powerchain from bracket to TAD – upright molars
  • TAD upper posterior segment to intrude
  • Won AJODO case prize 2018

 

Failure of buccal shelf screw Park 2004

  • Buccal shelf TAD 7%
  • Conventional mandibular TADs – between roots = 19%

 

Insertion of buccal shelf TAD

  • Upright
  • Mucogingiva – makes no difference as TAD is upright

 

Ramus TAD: Impacted 2nd molar

  • Use of Ramus TAD – 2x14mm – due to medial pterygoid muscle presence
  • Eyelet with powerchain threaded through –

 

Maxillary TAD Infrazygomatic crest IZC: Distalisation

  • Insertion at mucogingival junction
  • Initially 90 degrees when hit bone oblique angle significant approx. 60-70 degrees
  • 2mm x 12mm
  • Between 6-7
  • Not in between the roots, no requirement to remove / replace
  • Head left 5mm from the gingiva

 

Gummy smile with anterior TADs

  • Distal to upper central incisors 1.5 x 8mm
  • Power chain to intrude

 

References:

 

  • http://iaoi.pro/asset/files/jdo_vol_55.pdf
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