Case Study: Khai

This young man came to my office complaining that his front teeth shifted off to the right side of his face when he smiled. Upon further examination he was noted to have two front teeth over-lapped, and his bite on the right and left side were also extremely off. His mother complained that he was grinding his teeth really bad each night. He was also unaware that he was missing a lower left first bicuspid; all the which made this case even more challenging.

Whenever the top teeth do not fit together with the bottom teeth, it is like two sets of gears that do not fit together thus contributing to the grinding of teeth together at night. This bite condition is referred to as a Class II bite in orthodontics which contributed to the bruxism habit as it is referred to in dentistry. It can have devastating effects not only on the teeth, often causing fractured molars, but the temporo-mandibular joints as well creating what is commonly referred to as TMJ dysfunction or just ‘TMJ’.

I elected to correct the bite problem by pushing the midline over to the patient’s left while retracting the upper right molar to the right using a temporary anchor thereby creating space for the blocked-out lateral incisor. I also used a temporary anchor on the lower arch to align the lower dental arch with the upper arch so he would not need to have an implant placed in later years to replace the missing lower left bicuspid.

Total treatment time was a little over two years which is quite normal when protracting a bicuspid and all the molars on the lower left side to correct the bite and prevent the need to remove the wisdom teeth as well as the need for a tooth replacement option. His result was excellent as we not only corrected the bite on both sides while aligning the top teeth with the center of the upper lip, but we also eliminated the bruxism habit as well.