Predictable Orthodontics: Customized Minor Tooth Movement
The progression of orthodontic treatment now allows more general practitioners options to offer their patients. One such development, minor tooth movement (MTM), involves a simple orthodontic solution utilizing fundamental tooth movements to correct the anterior misaligned teeth or the “Social Six.” Taking into consideration that up to 50% of adult patients present with common anterior misalignment, MTM provides a predictable, customized, and properly staged plan in which to create an excellent result.
As with any potential orthodontic treatment under consideration, case selection is critical for success. A 28-year-old female patient presented with excellent oral health and a chief complaint of “crooked teeth.” She expressed concern about “traditional” braces and about any type of attachments being placed on her “front teeth.” Closer examination revealed common anterior tooth misalignment that fell within the minor tooth movement treatment parameters. After discussing all the options, we determined she would best benefit from convenient and minimally invasive orthodontic aligners created by the MTM Service Center.
Submitting a case to the MTM Service Center is easy and straightforward. Digital photographs and a template were created, a digital panorex was taken using the Orthopantomograph OP300 (Instrumentarium), and final detailed full-arch polyvinyl impressions were made using a 1-step combination method of heavy and light body Aquasil material (Dentsply Sirona), along with a bite registration. The patient’s digital information was submitted via www.mtmclearaligner.com and impressions were sent to the Service Center. From this submission, a technician created a detailed, customized proposal that included the number of aligners, each aligner’s specific tooth movement, and any necessary interproximal reduction (IPR) within that sequence. Also, 3D interactive models were available to visualize the treatment and proposed outcome. After review, approval was given before aligner fabrication.
In this case, 5 aligners were needed to correct the patient’s misalignment and a total of 1.3 mm of IPR was required in the mandibular arch. The first aligner set was delivered, 22/7 instructions for wear were given along with homecare, and the patient was scheduled to return in 3 weeks. Total treatment time was estimated to be approximately 4 months.
The patient was diligent in her aligner-wearing compliance and oral healthcare. IPR was staged accordingly and proper space created using the high-speed Midwest ATC Stylus handpiece (Dentsply Midwest) and an ARS fi ne diamond Safe-Tipped Bur (Dentsply Raintree Essix). Finishing strips were used on surfaces receiving IPR. Newly created space was measured using an interproximal measuring gauge and final surface smoothness confirmed using floss. She found the aligner wear to be very comfortable, gentle, and easy to insert. Each MTM Service Center aligner is created to provide a maximum of 0.3 mm movement per tray and is exchanged every 3 weeks. At the completion of active care, retention was achieved using an Essix PLUS – 0.35” plastic (Dentsply Raintree Essix) for the maxillary arch and a fixed, braided wire in the mandibular arch. The opportunity to correct anterior misalignment using a minimally invasive approach with the use of proper staging, force points, and an open-pathway architecture allows for a more natural tooth repositioning. Earlier schools of thought would have mandated traditional wires and brackets; however, current technology along with improved plastic materials allow dentists to offer an orthodontic option that promotes compliance, oral hygiene, and long-term esthetics.