1. Bond lingual wire behind the 11 and 21
This simple step can help keep your teeth together while the gingiva remodels. I suggest that you leave this in place for 4 years.
2. Tip the roots of the centrals slightly distally
When you see a diastema patient, you can tip the roots of your teeth during orthodontic treatment by misbracketing the centrals or making a gable up bend between the centrals. This helps set up your roots to counter the forces of the gingiva trying to push the teeth apart, back to their initial position.
3. Use a Wraparound Hawley retainer
4. Perform a fiberotomy
Cutting the gingival tissue between your patient’s centrals will help to prevent relapse expansion of the gum. Do a quick fiberotomy a couple of months before debanding. As an alternative to a fiberotomy, use a laser to sever the tissue between the centrals. While this may be an easier method than a fiberotomy, you can only do this if you have a laser machine.
5. Check to see if a frenectomy is needed
Pull on the upper lip to see if the premaxilla blanches. If blanching is noted, perform a frenectomy after the braces have been removed.
-New York, NY: May 19-20, 2018
-Orange County, CA: May 24-26, 2019
-Houston, TX: July 12-14, 2019