Treating a severe iatrogenic gingival exposure and lip incompetence - a challenge worthwhile.

This case reports the retreatment of a young adult who had a previous orthodontic history of inappropriate biomechanical strategies leading to iatrogenic effects with the formation of a dual occlusal plane causing anterior dental extrusion. As a result, an already severe dento-skeletal malocclusion with a vertical growth pattern, severe gummy smile, increased overjet and a very deep bite along with procumbent and incompetent lips became exaggerated. The high smile line and heavy convex profile were changed to an average smile line and a straight profile by intruding the anterior maxillary segment with anterior miniscrew anchorage and retracting the whole maxillary arch using IZC screws posteriorly. The treatment effect was similar to an anterior surgical impaction, thereby offering patients a viable alternative. Combining intrusion and gingivectomy produced an aesthetically pleasing smile and profile without the cost, morbidity, and potential complications of orthognathic surgery.

Physiologic Midtreatment Tooth Movement as a Correction Strategy for Iatrogenic Root Exposure.

In the case report showcased, we describe orthodontic treatment of a female patient with an excessive gingival display on smiling and severe dental crowding, with maxillary canines positioned excessively buccal (ectopic) to and in near transposition to the lateral incisors. The treatment involved extractions and initial use of unmitigated forces leading to excessive gingival thinning and buccal root positioning of the ectopic canines. Eventually, the root position was corrected and periodontal equilibrium was attained. On finishing the treatment, all objectives were achieved with a good esthetic outcome as well as excellent dental and occlusal relationships.

A Novel Temporary Anchorage Device Aided Sectional Mechanics for Simultaneous Orthodontic Retraction and Intrusion.

Closing spaces on light wires with inadequate knowledge and inappropriate mechanics can cause a "roller coaster" effect leading to an improper occlusion. Current knowledge of biomechanics, along with the incorporation of TADs, has made this process less challenging and more predictable. Resistance to sliding is considered the most prominent inhibitor of space closure in archwire-guided space closure or sliding mechanics, in turn delaying treatment duration considerably. In our case, resistance to sliding, primarily binding of the wire in the bracket slot, was nullified with the use of loop and sectional mechanics. This case report is aimed at showcasing the successful treatment of a young lady with a novel clinical setup to retract the canines into the premolar extraction space and simultaneously retract and intrude the anterior segment using sectional archwires and TADs in just under nine months. The current setup with sectional wires and TADs produced an uprighting, and an intrusive effect on the upper incisors during space closure. Additionally, the anchorage design avoided any significant change in the vertical dimension during sagittal correction of the Class II malocclusion. The occlusal plane remained almost stable with good amount of uprighting of the lower incisors following lower space closure too. The use of good biomechanical principles helped us achieve all the treatment goals and objectives in a very short period of time.