Part 2: Mark describes the clinical factors of space closure and an method of maintaining bone in space opening using miniscrews

Space closure aesthetic challenges

1. Gingival height: Canine’s height is superior to lateral incisor’s

2. Torque: Canine is of buccal root torque, and a lateral is palatal root torque

3. Morphology: Canine is wider and thicker than a lateral incisor.

1. Gingival height solution:

a. Bracket placement

· Canine bracket placed gingical = extrude gingival margin

· Premolar / bicuspid bracket placed incisal = ,intrude gingival margin

2. Torque

· Using a lower contralateral 2nd premolar bracket inverted:a achieves 17 degrees of palatal root torque and fits onto the surface of the canine

· Mophology

· Minimal prep veneer

· Narrow buccal lingual via reduction

Mechanics – tips for space closure

· Always push mechanics

· If pull mechanics– distort archform, and alter centreline

· TADs can be usedfor anterior anchorage

Space closure advantages over space opening

· Stable

· immediately finish,  no 2 stages

· Predictable periodontal health

· Possible in all malocclusions

· Maintains bone

· No prosthesis

· No evidence of functional problems

Space opening miniscrew to maintain bone

Does it work?

Miniscrews: increase density Al Maaitah AJODO

· 3/12 after placement

Follow up for 5 years = maintained bone and prosthesis, Ciarlantini 2017

How to insert?

o Lateral insertion = as vertical insertion of miniscrew shows infraocclusion

o Use of spring to maintain prosthesis

References

Al Maaitah, E.F., Safi, A.A. and Abdelhafez, R.S., 2012. Alveolar bone density changes around miniscrews: a prospective clinical study. American journal of orthodontics and dentofacial orthopedics, 142(6), pp.758-767.

Ciarlantini, R. and Melsen, B., 2017. Semipermanent replacement of missing maxillary lateral incisors by mini-implant retained pontics: A follow-up study. American Journal of Orthodontics and Dentofacial Orthopedics, 151(5), pp.989-994.