Part 2: Mark describes the clinical factors of space closure and an method of maintaining bone in space opening using miniscrews
Space closure aesthetic challenges
- Gingival height: Canine’s height is superior to lateral incisor’s
- Torque: Canine is of buccal root torque, and a lateral is palatal root torque
- Morphology: Canine is wider and thicker than a lateral incisor.
- Gingival height solution:
- Bracket placement
- Canine bracket placed gingical = extrude gingival margin
- Premolar / bicuspid bracket placed incisal = ,intrude gingival margin
- Using a lower contralateral 2nd premolar bracket inverted:a achieves 17 degrees of palatal root torque and fits onto the surface of the canine
- Minimal prep veneer
- Narrow buccal lingual via reduction
Mechanics – tips for space closure
- Always push mechanics
- If pull mechanics– distort archform, and alter centreline
- TADs can be usedfor anterior anchorage
Space closure advantages over space opening
- immediately finish, no 2 stages
- Predictable periodontal health
- Possible in all malocclusions
- Maintains bone
- No prosthesis
- No evidence of functional problems
Space opening miniscrew to maintain bone
Does it work?
Miniscrews: increase density Al Maaitah AJODO
- 3/12 after placement
Follow up for 5 years = maintained bone and prosthesis, Ciarlantini 2017
How to insert?
- Lateral insertion = as vertical insertion of miniscrew shows infraocclusion
- Use of spring to maintain prosthesis
Al Maaitah, E.F., Safi, A.A. and Abdelhafez, R.S., 2012. Alveolar bone density changes around miniscrews: a prospective clinical study. American journal of orthodontics and dentofacial orthopedics, 142(6), pp.758-767.
Ciarlantini, R. and Melsen, B., 2017. Semipermanent replacement of missing maxillary lateral incisors by mini-implant retained pontics: A follow-up study. American Journal of Orthodontics and Dentofacial Orthopedics, 151(5), pp.989-994.