April 3rd, 2017
Every once in a while there is a request in Dr. King’s office for a little post treatment help after non-compliance. It happens, a retainer gets lost, a permanent retainer gets broken, things happen and Dr. King understands that. Dr. King has developed a very successful procedure used when the space between the front teeth slowly returns and is not welcome.
Neal Kravitz, Editor for the Journal of Clinical Orthodontics requested Dr. King to contribute an article which describes a simple and esthetic solution he created for consolidating anterior spaces with light force and minimal effort. The technique evolved from a method of minor space closure in which a 1/8”, 2 oz elastic was placed around the central incisors and below the contact point in the gingival one-third of the tooth. This procedure is more comfortable, esthetic and predictable, requiring no special patient cooperation.
The included photos are of a 20 year old who lost his retainer a year previously. First, the anterior teeth to be bonded are isolated and etched and a bonding agent is applies. Next, a clear elastic thread* is cut to a length of 6” and positioned on the middle third of the crowns. A small teardrop of composite** is added over the thread on each tooth surface and cured one at a time. Maintaining tension as the elastic thread is lightly stretched across the teeth. This patient was bonded canine to canine and the space was closed in 10 days.
A space of 1mm or less can close in 24 hours if the thread is bonded fro lateral incisor to lateral incisor. If the patient has an overjet, space will rarely open distal to the lateral incisors. To avoid rotation of the upper lateral incisors, the patient should be scheduled to return to the office in 24 – 48 hours, since the teeth are being moved by uncontrolled tipping with no moment of a couple. If the lateral incisors begin to rotate, either excessive tension has been placed on the thread of the force has been exerted for too long.
If the patient is unable to return within two days, or if the rotation of the lateral incisors is a concern, the elastic thread can be bonded from canine to canine as shown here. Space closure will then take seven to ten days, but there is less risk of rotation due to the added anchorage of the canines. A bonded retainer should be placed once space closure is complete.