Dr. Rob Veis

Problem: Unsightly crowding of the upper anteriors.

Solution: A small amount of cosmetic tooth movement that will allow you to achieve an excellent cosmetic result with veneers instead of crowns.

How often have you had patients come in and ask if you could just straighten one tooth to give them a better-looking smile? It's a fact that most adults are unwilling to undergo complete orthodontic care. Yet, many of them would love to do something to improve the way their teeth look. Fortunately, there are many minor tooth movement procedures you can do that will give your patients the esthetic result they are looking to achieve.

A typical example of adult minor tooth movement is illustrated here. This patient has overlapping centrals and two peg laterals that are lingually placed. After a diagnostic wax-up was completed, it became clear that the patient had two choices. He could either have his teeth prepared for four crowns (possibly having to have intentional root canal therapy) or he could undergo some minor tooth movement to realign and evenly space out the anteriors prior to placing some veneers. The patient chose the less invasive orthodontic procedure.

In this case, using a simple Hawley retainer with distal kickers to move the centrals distally and finger springs to move the laterals labially was enough to complete the orthodontics. The total treatment time prior to placing the veneers was less than three months.

Multi-Spring Appliance intraorally.		Intraoral view of patient before treatment showing overlapping centrals and lingually placed peg laterals.		Multi-Spring Appliance on model.
Intraoral view of corrected alignment with minor tooth movement.		Patient's smile after minor tooth movement.		Patient's smile after treatment.

Treatment Procedures:

1. Start by taking a set of accurate alginate impressions and pour them up in yellow stone.
   
2. Take a centric occlusion bite relationship to ensure that the lab will be able to accurately articulate the models.
   
3. Evaluate the severity of the crowding and rotations of the anteriors. This will allow you to determine whether you will need to gain space first or just move teeth labially, lingually, mesially or distally. In adults, gaining space is often accomplished by a small amount of interproximal recontouring.
   
4. Check the relationship of the upper and lower anteriors to each other. If the patient's bite relationship is such that the upper and lower anteriors are making contact, you may not be able to move them, regardless of the amount of re-contouring performed or force applied by the appliance.
   
5. Fill out your lab slip completely. Just writing, "I want a multi-spring appliance" is not sufficient. Detailed instructions as to the type and placement of the springs and clasps are essential. If you need help selecting the right spring for the job, look at the section called "The Anatomy of an Appliance" in the Manual of Appliance Therapy for Adults and Children.
   
6. One week after placing the appliance, begin activation. Activation of the appliance should be done at least every four weeks. When opening the springs, they will often tend to ride up the lingual surface of the tooth you are trying to move. One method to prevent this from happening and keep a constant force on the tooth is to bond a small composite button on the lingual surface. This will allow you to engage the spring under the button preventing it from riding away from the tooth.
   
7. After tooth movement is completed, have the patient wear the appliance as a retainer for at least one month prior to placing the veneers. Once the veneers have been placed, a Dual-Flex® splint is an excellent final retainer. Its soft thermoplastic layer will prevent any abnormal forces from being placed on the veneers.