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Clinical Cosmetic Dentistry

After Six Month Smiles treatment. (Photo: Provided by Dr. Angie Nauman and Six Month Smiles)
Feb 12, 2014 | Cosmetic Dentistry USA

Changing lives a smile at a time

by Dr. Angie Nauman, USA

One of the aspects of dentistry that drew me to this field — an aspect I first became aware of when I was in fourth grade — was the incredible transformation that can be made with orthodontics. This case study from my general practice illustrates that rewarding aspect of the profession. I met Matt in Tulsa, Okla., when he was helping to redesign my website.

He was 26 years old — and a friendly, kind young man — but I could tell he was hiding behind his closed-lip smile.

Fortunately, Matt’s wife started coming to our office for her dentistry needs, and Matt soon followed.

Matt didn’t come to our office because he was concerned about his looks — he wanted his teeth straightened because he kept biting his lips. At the time, I had been treating Six Month Smiles cases for a year, and I knew I would be jumping into a big case, but I couldn’t help but imagine how his smile — and his life — could be changed.

On the day of impressions, my treatment plan for Matt was to extract one of his lower incisors to create space for alignment. He was in agreement with what I suggested. I spent time on the Six Month Smiles forum while his case was at the lab, and I changed my mind and decided to proceed without any extractions. I knew this would require interproximal reduction, but I knew that because Matt is a smaller-framed man, his smile would still be proportional to his overall appearance if the teeth were slightly more slender.

Delivery of Six Month Smiles went well, and Matt was thrilled that he did not need to have a tooth extracted. He adjusted well during the first month and continued to have a great attitude throughout treatment. We started with 0.014 wires, and slight IPR throughout (“slight” because I like to take it easy with IPR at the braces-on appointment).

During the first two monthly visits, I kept 0.014 wires and added on many wire ties to help the wires engage fully into the brackets. I reduced the bite-guards at each visit as his bite would allow.

The next few months’ treatment included the 0.016 wires — and rubber bands in a box shape between upper canines and premolars to lower canines and premolars. Then we moved up to 0.018 with powerchains on the mandibular incisors to tighten contacts. I was surprised that at the seven-month mark, his lower teeth were beautifully straight and his occlusion was good, so we were able to remove the lower braces. Matt's oral hygiene was sub-par, so I was glad we could remove the lower brackets so that he could focus on improving his gingival health.

Within two weeks, his upper teeth were aligned beautifully. We took his braces off and bonded #8 to complete his new look.

Total treatment time was seven months for lower and 11 months for upper. Matt was extremely happy with his new smile, and I was happy with the result.

Cosmetic orthodontics for adults can be very rewarding. When the patient does not want to go through comprehensive orthodontics, we now have a viable solution for those patients through Six Month Smiles.


(Note: This article was published in Dental Tribune U.S. Edition, Vol. 9, No. 1, January 2014 issue.)

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