Orthodontics Case Study – Dr Matthew Sudderick

Hello,

I wanted to share an orthodontic case that I carried out a few years ago and the sort of treatment that we can carry out here at Moreton.

This was a 22 year old male patient that presented with severely crooked teeth, which were affecting his self-confidence. His problem was compounded as he had lost an upper front tooth in a car accident when he was younger, resulting in the crooked development of his teeth and the centreline being lost.

To begin with, we take a thorough set of records, which include X-rays, clinical photographs and impressions. In this case, the impressions were sent to a laboratory to produce an appliance for the patient’s upper jaw, which is called an ALF (Advanced Lightwire Functional) Appliance – see fitted in the photo below.

The aim of the ALF Appliance is to re-align the distorted bones within the skull by exerting outward pressure on the jaw, creating more space for the teeth to fit. This light, continuous force results in a wider, more symmetrical jaw shape, as well as proving more room for the tongue to fit and function properly in the mouth.

The treatment plan involved wearing this appliance for a period of 6-12 months and then wearing a fixed (‘train-track’) brace for another 12 months, with the lower jaw being started a bit sooner.

As with everything in life, and dentistry, you learn best from the things that don’t go to plan. In this case, the first part of the treatment with the ALF appliance went really well, and you could see the spaces begin to develop. I fitted the lower fixed brace (see photo) and then fitted the upper brace after 9 months of the patient wearing the ALF.

However, as you can see in the photo, I was unable to correct the upper centreline without extracting a tooth from the left side. The purple ring highlights the UL4 tooth which I decided to extract mid-treatment, but this would have been better to have extracted at the start! This added an extra 6 months to the overall treatment time. However, extracting this tooth allowed the adjacent teeth to be pulled across and achieve the correct centreline and

optimise the patient’s appearance.

So after 26 months of treatment, we were able to take the braces off, place fixed retainers and make removable retainers. I think you will agree that after all that time, the result was worth it!