Should it be crown lengthening or orthodontic intrusion?
Compare the gingival margin, the incisal edges and the length of the crown of adjacent teeth to decide.
This patient had a long standing malocclusion with crowding and a deep bite. Also, he was a bruxer. If you check the before picture you will see that the tooth 11 not only has lost 1.5mm off the incisal edge; but also, the tooth has over-erupted.
The over-eruption of tooth 11 is diagnosed by the fact that the gingival margin of tooth 11 is more incisal than the gingival margin of tooth 21.
This case is currently in treatment. In the progress picture you can see that the gingival margin of both incisors is level from one tooth to the other. If you look closely you will also see that 1.5mm of tooth coloured acrylic has been added to the incisal edge of the 11 to replace the dental material that was lost from the bruxing habit.
After orthodontic care is completed, this patient’s dentist will restore the 11 properly to the correct dental proportions.
Crown lengthening will not be necessary in this case.
On another topic, my buddy Dr. Jim Hyland is giving a periodontal webinar on December 18, called “Stop The Bleeding”. I’ve attended one of his live presentations and fount it enlightening. Here is the link for more information:
PS: I have moved my office to join a group practice at Sheppard Yorkland Dental across the road from Fairview Mall. The phone number is the same so please continue to call me! Please feel free to share this with friends. If you have a friend who would like to be on the “Ortho tips” list please let me know.
Why can’t everyone’s ideal occlusion be the same.
Because everyone has a different skeletal structure.
I saw a patient last month for a retainer recall. He came with his father for his appointment.
I checked the lingual bonded wires; I checked his upper and lower night time retainers; I checked his Masseter muscles for tonicity; I checked his jaw joints for clicking. There were no problems. I congratulated them for everything being OK and said “See you next year”.
Then the dad said “My wife wants to know why my son’s teeth are sticking forward!”
(Of course, it’s always the parent who is not there who needs to know.)
This was an opportunity for me to explain about dental compensation for skeletal disharmony.
This patient has a prognathic mandible and a concave midface. In an extreme situation the teeth would be in an anterior crossbite and would have required Orthognathic surgical assistance to get a Class I occlusion. However, this was not an extreme situation and I felt that if I tipped the upper incisors forward and the lower incisors back, I could achieve an acceptable and stable occlusion without jaw surgery.
You can see in the photos that there is dental compensation to accommodate the large mandible and small maxilla. It is not an ideal Class I occlusion. It has a tendency to Class III and there is also a tendency to posterior crossbite as well.
I feel that this was a good choice in this case. Many of my other cases do require Orthognathic surgery when the skeletal disharmony is too large.
PS: I have moved my office to join a group practice at Sheppard Yorkland Dental across the road from Fairview Mall. The phone number is the same so please continue to call me!
Please feel free to share this with friends. If you have a friend who would like to be on the “Ortho tips” list please let me know.
p.s. If you prefer not to get these OrthoTips please return this email with a “No Tips Please” comment.