One of my favorite orthodontic cases

Sept. 19, 2013
Christopher D. Williams, DDS, goes through one of his favorite orthodontic cases, one in which he and his dental team positively changed someone’s life. Here, he covers the extraction of a supernumerary tooth, as well as wires, brackets, X-rays, bleaching, and a retainer.

First off I'm not an orthodontist nor do I play one on TV, but I was at least partially trained at a Holiday Inn Express. I have taken several comprehensive orthodontic training courses including Dr. Robert Gerety's course, Progressive Orthodontics, and a hands-on tip edge course in Austin with Dr. Jeff Gerhardt.

This is a case that I took on early in my career as a wannabe orthodontist.

She came to me for an orthodontic consultation. She was 24 years old and hoping to marry her then-boyfriend at some point, but she didn't like her smile; she felt it was unattractive. So we gathered her orthodontic records and pointed out to her that it appeared she had either a supernumerary tooth or over-retained primary tooth between her upper centrals. Along with this, she also had some minor crowding on her lower teeth. She had a Class I molar relationship that I hoped to maintain.

After getting her cleaned up, we presented her with a treatment plan of extracting the upper supernumerary tooth, closing the space between her upper centrals, an in-office bleaching treatment, and later restoring them by removing the caries and bonding composite.Treatment progression

Extraction of supernumerary tooth —
Month 0-3 I like to start all my orthodontic cases off with a light round nickel titanium wire such as an 014N or 012N. While in this wire, I used some elastomeric chain to help align and rotate the teeth.Month 4-10 I continued to level the teeth and begin to reposition brackets on a 18X25 heat-activated NiTi wire based on a panoramic X-ray that I like to take to help me with root positioning.Month 11-16 Progress to a stainless steel 19x25 wire for more tooth torque and better bracket engagement.Month 16-18 Finishing on a 018SS. I don’t have much wire-bending skills, so I mostly move brackets and am capable of only some simple step bends.

Bleaching —
We debanded the upper and performed a Zoom bleaching up top. At that time we also impressed to make a lower bonded lab-fabricated retainer. (I know we should do this in-office.)
When the patient returned, we delivered the retainer and removed the last of the brackets. The patient was more than thrilled with the final outcome of the case. That was one of our first cases, and I'm sure at this point we could manage the case more efficiently. I call this one of our best cases not because of the orthodontic challenges. Most dentists out there could do a better job. Today we may have offered her a lovely set of veneers to really knock it out of the park. But the reward was great, because I feel we possibly changed someone's life. The positive change in her smile and appearance gave her a newfound confidence.
Christopher D. Williams, DDS, is originally from Orange, Texas. He graduated from Prairie View A&M University and next earned his D.D.S from the University of Texas Health Science Center – San Antonio in 1997. He is a member of the American Orthodontic Society and the Academy of GP Ortho. Dr. Williams owns practices in New Braunfels, San Antonio, and Seguin and practices orthodontics full time spread between the three locations. Dedicated to continuous education, he has more than 600 hours of orthodontic continuing education. Dr. Williams enjoys working with his patients the most. He is married and has two boys. In his free time he loves attending football and basketball games. Go Texans! Go Cowboys! Go Spurs! Visit his website at http://mytoothtime.com.