Closure of multiple maxillary diastemata in a patient with deep overbite and accentuated curve of Spee - Case report

Abstract

tps://doi.org/10.1016/j.jds.2020.07. 91-7902/a 2020Association for Denta e CC BY-NC-ND license (http://creati Etiologies of maxillary diastema include high frenal attachment, small tooth-size in relative to jaw-size, pathological tooth migration, and deep overbite with steep incisal guidance. Patients seek for treatment are mainly due to esthetics and phonetic problems. This 26-year-old female patient was under orthodontic treatment for one year elsewhere before she visited to our hospital. She complained of multiple maxillary diastemata that became wider than pre-treatment and wished to close these spaces at the maxillary anterior region to improve her protrusion. Extraorally, she had bimaxillary dentoalveolar protrusion with procumbent lips, acute nasolabial angle and gummy smile with prominent spacings between maxillary incisors. Lower dental midline was deviated towards the left, but without prominent facial asymmetry (Fig. 1A, B, C and D). Intraorally, she had full mouth fixed appliance, and both arches were in round stainless-steel wires for space closure with power chain (Fig. 1 E). Bilateral molar relations were end-on Class II and incisors showed 6mm large overjet and 6mm deep overbite with accentuated curve of Spee, causing upper palatal gum impingement (Fig. 1F and I). Left maxillary first molar and right mandibular lateral incisor were mesially rotated due to bonding error, and there were improper interproximal reductions from the left lower second premolar to the right lower first premolar (Fig. 1G and H). Treatment goal was to