The Smile Journey: One phase at a time

Boston_Marathon_Werl_1Author – Shalin Raj Shah, DMD, MS

The orthodontic smile journey succeeds as much through careful planning and execution as it does by working in concert with the patient.  We thought it fitting that Meb and Hilary demonstrate finishing together is stronger and more impacting than what we may able to do alone.

Melina’s last visit to @Coesmiles was another productive team effort.  She was pleasantly surprised at the ease of removing the temporary anchorage devices (TADs), and Melina began the last leg in completing the Phase I leveling & aligning process. 

As is seen on the upper occlusal photo below, Melina’s palate healed normally, and the four TADs were removed unremarkably.  On November 8, 2014, Melina received upper and lower 0.020” x 0.020”  BioForce® arch wires.  During her visit on March 21, 2015, we fully transitioned Melina into her last set of Phase I arch wires: upper and lower 0.019” x 0.025” NeoSentalloy®.  The goal of Phase 1 is to complete most of the gross movements as they relate to leveling and aligning of the teeth in preparation for the working stage (Phase 2).  Phase 2 will have a primary focus on systematically building Melina’s static and functional occlusion by way of completely leveling both occlusal planes, coordinating arches, and sliding teeth.

Phase 1 - click to enlarge
Phase 1 – click to enlarge
Phase 2 - Click to enlarge
Phase 2 – Click to enlarge

It is important to note that the bite may open as the maxillary and mandibular occlusal planes begin to properly level.  This is a normal occurrence, and it is a correctional goal we address in Phase 2. Furthermore, our typical approach is to wait until the 0.019” x 0.025” SS wires fully express the CCO® prescription prior to assessing the need for any repositions by way of a progress panorex and/or clinical findings.  Dr. Celestino Nobrega has demonstrated that an 0.019” x 0.025” SS arch wire in an In-Ovation bracket with an 0.022” x 0.028” slot-size will exhibit the full prescription of the bracket.  This enables a complete and thorough evaluation of each tooth’s tip, torque, labio/lingual, and inferior/superior position when evaluating the next steps required to detail the occlusion. (see article “Biomechanical Behavior of Self-Ligating Interactive Systems” by Dr. Nobrega)

Melina will be returning in approximately twelve weeks as the 0.019” x 0.025” NeoSentalloy® continue to achieve the goals of Phase I.  We will post updated photos of Melina’s progress at that time.  Until that next visit, we will continue to discuss how we identified Melina’s etiologic factors and subsequently established her diagnosis and treatment plan.  Melina has promised to work on her oral hygiene during those months as well!

As discussed in Melina’s previous post we will next explore converting the lateral ceph to a seated condylar position, as well as the value of a growth prediction prior to completing Melina’s orthodontic treatment design.

We leave you with this image that will serve as part of the next discussion.  We also would like to congratulate all those who finished the Boston marathon!  You inspire us to work harder, collaborate further, and love stronger!!

MP Case Photos 3
Click to enlarge

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Click to see Melina’s journey thus far at The Melina Project.




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