Dr.Monik Vasant shows a case with small upper lateral incisors that were planned with an ortho-restorative approach
This young gentleman attended looking to improve his smile. He had neglected his teeth for a few years and his new job had made him very conscious of his smile.
He didn’t like the crowding of his teeth and especially hated the very small lateral incisors. He recalled fracturing his upper left canine many years ago following a bottle opening incident.
On examination he was found to have fairly poor oral hygiene with some gingivitis that required attention prior to any orthodontics.
The lower arch showed moderate to severe anterior crowding with a deep bite. The posterior occlusion was a class I molar and canine relationship with good intercuspation. The upper lateral incisors were particularly small especially the UL2, the UL3 was fractured and the upper central incisors showed differential wear. The gentleman was initially treated with intensive oral hygiene advice and debridement sessions and the oral hygiene improved considerably.
Options for aesthetic and bite improvement were then discussed and the options included referral to a specialist orthodontist or anterior alignment treatment using the Invisalign system. The gentleman opted for Invisalign treatment. We discussed rounding out his arches to improve the buccal corridors which would give us some space to align the teeth and minimise the amount of interdental stripping required. As the upper crowding was less severe this would give us some excess space which we could consolidate around the upper laterals to enable
us to build them up to a normal tooth proportion at the end of the orthodontic work. In addition, I advised that we could also perform some composite bonding to the upper centrals and the upper left fractured canine. We decided to also temporise the UL3 during the alignment phase.
The alignment was carried out over 12 months and the patient was happy with the outcome. The composite bonding was subsequently performed using a layering composite material (Miris 2, Coltene) over a single visit with a subsequent visit for fine polishing. The patient was provided with Vivera retainers to be worn nightly indefinitely to prevent relapse
Fact File: Dr. Monik Vasant BChD MFGDP (UK) MSc
Highly experienced clinician with a special interest in minimally invasive aesthetic dentistry. He is the director of Freshdental with sites in Central London & Greater Manchester. He lectures on various postgraduate courses both in the UK & internationally. His popular composite course ‘Totally composite’ is independently run and covers all aspects of anterior and posterior composite work. Global key opinion leader for Coltene and clinical lead on the development team. He is also on the European Aesthetic Dentistry Advisory Board and a clinical speaker for Invisalign and an opinion leader for Sirona on digital dentistry