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MUHAMMAD SAUD

Relapse is a common problem in orthodontics


How to prevent relapse in Diastemas ?

Different Orthodontists have different choices:


o Permanent retention
o Removable retainers
o Frenectomies
o Circumferential fibrotomies

ARCHWIRE REMOVAL AND CLINICIAN CONCERNS:


Approach in which all archwires are removed during
treatment , for atleast 6 weeks, to check potential for
relapse
Teeth "rebound" and attempts to put themselves into
equilibrium with muscles and function

"GEDANKEN" EXPERIMENT: (Thought experiment):


Approach that Einstein used when arriving at a number of
scientific facts
Creating experiments in his mind without actually
performing them (Mental Experiment)
E.g. asking question: if theres any other situation where
space reopens after closing?
Answer would be space closure after extracting premolar
2nd question: what if you tip the crowns more than the
roots towards each other will it prevent?
Ans: yes but itll be dangerous to Periodontal problems

STABILITY CONSIDERATIONS
How long will it take for the required movements to
occur in order to reach stability ?
It varies in individual patients
Can only be determined by archwire removal
There is no predictable number of times for archwire
removal to achieve stability
FACTORS:
1. Relationship between incisors crown and root
2. Amount of crown divergency and apical convergency

1. Relationship between incisors crown and root

Parallel roots after


space closure

spaces reopened

2. Amount of crown divergency and apical convergency

Crown severely tipped good for stability but


hazardous for periodontal tissues

CONVERGING APICES

DIVERGING APICES

DESIRED POSITION

STEPS:
Wire removal

Checking movements for stability


Do Not Discard The
Wire

When final stability is achieved

Incisal edges be reshaped with a diamond disk

Brackets repositioned

ROOT DIVERGENCY
If crown widths are normal the divergence of roots will
result in some overjet.

The overjet produced can be used to


solve other potential problems:

* Diastemas
* Small lateral incisors
* Slight Class-III incisor relationship correction

CASES:
2 sisters midline diastema treated , with no retention
required at all. 4 Yrs Post-treatment.

Archwire
removed 4 times

Archwire removed
once

GENERALIZED SPACING:
Space resulting from small lateral incisors can be eliminated by
Diverging the lateral roots

Mesiodistal width is increased

Results in canted incisal edges

Edges can be contoured

brackets can then be repositioned if additional Rx is required

MODIFIED MECHANICS
Continuous arch engaged into all brackets cannot
produce pure moments on the four incisor brackets
modified mechanics is needed
Two individual segments are used

Two off-center bends

Center bend
Produces equal & opposite couples

CASE:
Diastema closed before eruption of canines
No retention was ever used
Early treatment was done with the knowledge that
stability produced at this age would be further
enhanced with the eruption of additional teeth
Radiographs were carefully studied to ensure no
danger to the roots of developing Incisors

8 years post treatment

DARK TRIANGLE
Interproximal reduction of the central incisors must be
accomplished before complete closure of the diastema,
to prevent distal root movement instead of mesial crown
movement
There will be greater mesial movement of the incisor
crowns and less distal movement of the roots, although
the change in inclination will remain the same

CONCLUSION
*Closing midline diastema with out permanent retention
required is possible with bonding four brackets, using the
two anterior segments : a center bend and two off-center
bends.
*All orthodontists seeking stability, instead of permanent
retention, will begin removing archwires during
treatment.

THANK YOU