CASE-033 · Complex Cases

Adult Spacing and Worn Anterior Restorations — Orthodontic-Restorative Interface

An adult with generalised anterior spacing, mismatched existing upper anterior restorations, an uneven incisal plane and posterior wear, where the orthodontic goal was to position the teeth for a restorative finish rather than to close every space.

Findings: 05
Options: 03
Stages: 05

Complex CasesFixed OrthodonticsDigital Planning

Clinical records · drag to compare

Post-treatment frontal intraoral view with redistributed space and level incisal plane

Pre-treatment frontal intraoral view showing anterior spacing and mismatched restorations

BEFOREAFTER

↔

Clinical challenge

Deciding which spaces orthodontics should close and which should be redistributed for the restorative phase, without over-retracting an anterior segment already carrying restorations.

Outcome

Space allocated to plan, a level incisal plane, coordinated restorations of correct proportion, and restored anterior guidance.

Diagnostic findings

Generalised anterior spacing in both arches with open contact points
Existing upper anterior restorations of differing width, shade and emergence
Uneven incisal plane with a shortened lateral incisor display
Posterior occlusal wear with flattened cuspal anatomy
Recession and blunted interdental papillae in the lower anterior region

Problem list

Spacing distributed unevenly relative to ideal tooth proportion
Restorations dictating apparent tooth width rather than the reverse
Loss of anterior guidance from worn and shortened edges

Treatment objectives

Redistribute space to match planned restorative widths
Level the incisal plane and re-establish anterior guidance
Align roots so that emergence and papilla support are achievable
Close only the spaces that should not be restored

Options weighed

Full orthodontic space closure
Simplest finish; would compress teeth into widths the restorations cannot support.
Restorative-only widening
Fast, but bulks the existing restorations and leaves root positions unfavourable.
Orthodontic space redistribution then restorative finishing
Longest route; the only one where both tooth position and proportion end up correct.

The decision

Orthodontic space redistribution guided by a restorative plan agreed before bonding — the spaces were treated as a resource to be allocated, not a defect to be erased.

Clinical reasoning

The complaint was spacing, but the constraint was proportion. Closing everything would have produced narrow, crowded restorations and unstable contacts. Working backwards from the planned restorative widths turned an ambiguous space-closure case into a set of defined target positions.

Strategy

Fixed appliances with segmental space control: consolidate the posterior segments, hold planned anterior spaces open with passive coils, level the incisal plane, and align roots to the restorative wax-up before debonding.

Biomechanics

Continuous archwire with soldered stops maintaining allocated spaces, light vertical elastics for incisal plane control, and torque adjustments to bring anterior roots into a favourable emergence position.

Treatment sequence

01Restorative plan and digital wax-up agreed first
02Levelling and posterior consolidation
03Anterior space redistribution against archwire stops
04Root positioning and incisal plane detailing
05Debond, retention, then restorative finishing

Digital workflow

The wax-up was superimposed on the intraoral scan to define exact space targets per tooth, so every millimetre of space had a stated destination before the appliance moved anything.

Monitoring, adaptations & reassessment

Space widths were measured against the plan at each visit rather than judged by eye.

One upper lateral space closed 0.8 mm more than allocated; the coil was reactivated and the adjacent contact reopened rather than asking the restorative phase to absorb the error.

Anterior guidance was reassessed after the restorative finish to confirm the worn edges were no longer the contact of last resort.

14 · Clinical takeaway

In a restorative interface case, orthodontics is not there to close space — it is there to put the space where the restoration needs it.