Expanding the Lower Arch Is it Really a Forbidden Frontier: Flavia Artese
Summary of webinar from the AAO, looking at lower incisor change and orthodontics
4 indications to change lower incisor position:
- Good profile with arch length discrepancy
- Level lower arch curve of Spee
- Class 3 dentoalveolar decompensation
- Class 2 compensation
3 Factors which determine gingival recession for orthodontic patients
- Visible plaque – most important
- Amount of proclination – least understood
- Periodontal biotype / phenotype – can be altered
3 biotypes
- Thick -flat : Broad zone of KT, thick gingiva, square teeth
- Thick- scalloped: Narrow zone of KT, Thick gingiva, Slender teeth
- Thin – scalloped: Narrow one of KT, thin gingviva, triangular teeth
Assessment of biotype
- Clinical, including probe to assess translucency
- CBCT
- CBCT studies show greatest recession in Canine and Premolar region
Conclusion
Avoid expanding / proclining lower arch, if required then indication for periodontal surgery
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