Missing teeth and bony deficiencies. Exploring Dilemmas and Dogma. Mark Wertheimar. Part 2 Episode 21. August 4th 2020

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Farooq Ahmed

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


  1. Gingival height: Canine’s height is superior to lateral incisor’s
  2. Torque: Canine is of buccal root torque, and a lateral is palatal root torque
  3. Morphology: Canine is wider and thicker than a lateral incisor.


  1. Gingival height solution:
    1. Bracket placement
  • Canine bracket placed gingical = extrude gingival margin
  • Premolar / bicuspid bracket placed incisal = ,intrude gingival margin
  1. Torque
  • Using a lower contralateral 2nd premolar bracket inverted:a achieves 17 degrees of palatal root torque and fits onto the surface of the canine


  • Mophology
  • 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


  • Stable
  • 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 orthopedics142(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 Orthopedics151(5), pp.989-994.



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