Papakostopoulou Margarita, Stradi Roberto

Title: TADs and lingual orthodontics partnership: A case report

Aim: Restoration of facial/smile aesthetics and occlusal stability in a patient with upper midline diastema, peg laterals, lower anterior dental crowding and upper first molars with poor long-term prognosis.

Materials and methods: A 16-years old female patient with a meso-dolicho facial pattern and a skeletal class I malocclusion presented with upper midline diastema, peg laterals, one in linguo-occlusion, moderate lower anterior crowding, molar and canine Angle Class I, regular overbite/overjet. Radiographic examination showed that 16 and 26 were endodontically treated with extensive coronal restorations and clinically presented periapical reactions. All four third molars were present. The treatment plan involved Incognito® appliance 7-7 in upper arch for diastema closure between 11,21 and space opening between 11,13/21,23 for crown build-ups of 12,22. Extractions of 16,26 followed by mesialisation of 17,27 first by means of an elastomeric chain and then with direct anchorage from to 2 TADs, placed bilaterally of the palatal suture. In lower arch regular Incognito® appliance 6-6 with overties in the anterior segment to solve the crowding was used. Finally, vertical elastics were used on 3 buccal buttons, to maximise approximation in the canine region. Treatment duration was 3 years.

Results: An improvement in facial/smile aesthetics and stable occlusion were obtained.

Conclusion: Lingual braces together with TADs are very efficient in closing extraction spaces.