How to prevent the dreaded central diastema relapse - 5 Pro Tips from POS Instructor Dr. Shockley Wier

Posted by POS Course Adviser on 8/16/17 2:32 PM
One of the best moments in our professional world is seeing an overjoyed patient leave with a beautiful orthodontic finish. After working with them for two years, you both can appreciate the accomplishment. However, have you ever had a follow up appointment with one of these patients having a less beautiful smile than before? The most common post-orthodontics issue is when teeth go back to their original position. One of the most annoying types of these relapse moments is when we see a diastema opening up again, front and center.
Although you've positioned the teeth and jaws properly in your orthodontic patient, sometimes dentists forget about one small part of anatomy, gums. Gingival fibers can take 2-3 years to fully remodel, and if squished between the centrals, may want to move back to their original position.
So how can you prevent a diastema from opening up again in your patient's upper midline? Follow POS instructor Dr. Shockley Wier’s 5 pro tips so you never again have to feel frustrated with relapse diastemas.
Which of these 5 tips would you use for this patient? Read her full orthodontic story here.

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

When you deband your patient, create a Wraparound Hawley retainer to keep the teeth stable, preventing the centrals from moving apart.


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.

Want more orthodontic mechanics tips? Attend our Orthodontic Mechanics course at one of these locations:
-Virtual Classroom: November 13-15, 2020
-Chicago, IL: Fall 2021

Do you have any tricks for preventing relapse? Share in the comments below.

Topics: POS Instructor Tips, Tips for Success, Current POS Students, Mechanics

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