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Tricks of the trade: Pushing for success in lower arch space closure

From Volume 15, Issue 1, January 2022 | Page 48


Naeem I Adam

BDS (Hons), PgCert MedEd, MSc, MOrth, FDS (Orth)

Post-CCST in Orthodontics, Leeds Dental Institute, Chesterfield Royal Hospital, St Luke’s Hospital, Bradford

Articles by Naeem I Adam

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Orthodontic tooth movement is subject to Newton's Third Law of Motion. Exerting forces on teeth creates equal and opposite reactionary forces with the potential to cause unwanted tooth movement and impede the achievement of treatment aims. How these reactionary forces are managed forms much of the basis of the art and science of orthodontics.

Space closure can be approached through a variety of means, but the key features of the occlusion and any unwanted consequences of the chosen mechanics must be carefully considered.

This case highlights the left buccal occlusion of a Class II division 2 case transferred midway through treatment (Figure 1). There is no further requirement for the space that has been created by the loss of the lower left first premolar (LL4), so ideally the posterior teeth in the lower left quadrant need to be protracted. The combined root surface area of the lower left second premolar and first and second molars (LL5, LL6 and LL7) is far in excess of those teeth in the labial segment in the same quadrant.1 This situation then creates an unfavourable anchorage balance and routine intra-arch space closing mechanics here would result in a shift in the lower centreline, and an increase in the overbite and overjet because there would be reciprocal distal movement of the LL3 into the extraction space, leading to a Class II buccal relationship at the end of treatment.2

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