Interdisciplinary treatment Ortho-Perio

This is the case of a 38-year-old patient, a former smoker, who decides to take charge of herself and improve her oral health and smile. She didn’t believe it might be possible to “save” her teeth.
Slide 1, 2, 3:
Her dentist recommends her to the proper care of a periodontist. The latter therefore undertakes periodontal root scaling treatments. Antibiotics were needed. The lower 3rd molars were extracted. The patient was to receive planes every 3 months and maintain optimal oral health. She tells me that in the evening, it takes her 20 minutes to do the “big cleaning”, not counting the 3 other times she brushes her teeth during the day.
Slide 3, 4, 5, 6
Class II div 2 malocclusion, dental overbite, iatrogenic absence of the upper left canine. Generalized bone loss, tooth mobility. Guarded or hopeless prognosis for several teeth.
Slide 7, 8
Tx plan and alternative tx
Slide 9.10
I used a removable appliance with an anterior bite plane and a cantilever spring to intrude the upper right canine and reduce occlusal forces when leveling and aligning the lower dentition. The bite plane helps prevent trauma from occlusion (TVO) and the shudder that this generates on trauma teeth.
Slide 11, 12
Biomechanical principle that must be taken into account to perform the dental movements required in a situation of loss of dental support.
Slide 13, 14, 15, 16
Evolution of treatment. Extraction of the upper right second premolar (hopeless periodontal prognosis). Retraction and intrusion of the anterior segment with a retraction spring and segmented arch.
Parallelization of the 16-14 roots with a “root spring”. Retraction of the canine with a elastomeric link attached to a power arm.
Enmasse retraction on a 20x25SS arch wire in order to have maximum rigidity to produce a high moment at the wire-bracket interface.
Slide 17, 18, 19, 20, 21
Final result. Superposition of the initial and final traces in order to demonstrate the nature of the dental movements obtained.
Panogram showing the bone levels that were maintained during the treatment.
The last slide shows a significant improvement in the aesthetics of the smile.