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CASE-035 · Fixed Orthodontics

Crowding with Rotated Posteriors and an Unstable Anterior Contact

Moderate crowding with rotated and imbricated posterior segments, an irregular lower incisal plane and an anterior relationship that met edge to edge without a stable contact — treated by rebuilding the contact pattern rather than only straightening crowns.

Findings
05
Options
03
Stages
06
Fixed OrthodonticsComplex Cases

Clinical records · drag to compare

Post-treatment frontal intraoral view with aligned arches and distributed anterior contact
Pre-treatment frontal intraoral view showing crowding and an edge-to-edge anterior relationship
BEFOREAFTER
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Additional records

Post-treatment smile view with an even incisal plane
after
Post-treatment close smile view showing balanced tooth proportion
after
01

Clinical challenge

An anterior segment that touched without holding: incisal contact existed but was not distributed, so the front teeth were loaded in a pattern the arch could not support long term.

02

Outcome

Aligned and derotated arches, level incisal planes, anterior contact shared across the segment, and restored hygiene access.

03

Diagnostic findings

  • Moderate upper and lower anterior crowding with rotated incisors
  • Rotated and imbricated posterior segments reducing effective arch length
  • Edge-to-edge anterior relationship without a distributed stable contact
  • Irregular lower incisal plane with early edge wear
  • Localised gingival inflammation at the crowded contact points
04

Problem list

  • Anterior load concentrated on a small number of contacts
  • Posterior rotations masking available arch length
  • Crowded contacts limiting hygiene access
05

Treatment objectives

  • Recover arch length by derotation before considering enamel reduction
  • Level the incisal planes and distribute anterior contact
  • Coordinate the arches transversely
  • Retain the corrected contact pattern, not only the alignment
06

Options weighed

  • Aligners with staged IPR

    Acceptable aesthetics, but posterior derotation and torque control were the demanding parts of this case.

  • Fixed appliances with derotation-first sequencing

    Best control of posterior rotations and anterior torque; chosen.

  • Alignment only, accept the anterior contact

    Rejected — leaves the loading pattern that produced the wear.

07

The decision

Fixed appliances, derotation first, with anterior torque and levelling planned before any contact refinement.

08

Clinical reasoning

The crowding was the visible finding; the unstable anterior contact was the one that would decide longevity. Derotating the posterior segments returned arch length without proclination, which then allowed the incisors to be levelled and torqued into a position where contact could be shared across the segment instead of carried by two teeth.

09

Strategy

Sequenced fixed mechanics: posterior derotation and arch coordination, then levelling, then anterior torque expression, finishing with contact refinement and settling.

10

Biomechanics

Light continuous forces with progressive archwire sequencing; torque expression was deferred to the working wire so the incisors were not proclined during early alignment.

11

Treatment sequence

  1. 01Hygiene phase and baseline records
  2. 02Posterior derotation and arch coordination
  3. 03Levelling of both incisal planes
  4. 04Anterior torque expression
  5. 05Contact refinement and settling
  6. 06Fixed lingual retention with a removable overlay at night
12

Digital workflow

Arch-length auditing quantified the space returned by derotation, so interproximal reduction was scheduled only where the ledger still ran short.

13

Monitoring, adaptations & reassessment

Six-week reviews with contact checks on the anterior segment, tracking whether load was spreading as the incisal plane levelled.

Planned IPR at two lower contacts was cancelled after derotation returned enough space to align without enamel reduction.

Anterior guidance was reassessed after settling to confirm contact was distributed rather than concentrated.

14 · Clinical takeaway

Straight teeth are not the same as stable teeth. Fix the contact pattern and the alignment holds.

Related cases

Related clinical notes
Pre-treatment frontal intraoral view showing anterior crowding and rotationsقبل العلاج
Post-treatment frontal intraoral view with aligned anterior segmentsبعد العلاج

CASE-032 · Fixed Orthodontics

Adult Anterior Crowding with Rotations and Attrition Risk

المقاربة
Fixed Orthodontics
الموجودات
05 مسجّلة
المراحل
05 مخطّطة
Pre-treatment frontal intraoral view showing anterior spacing and mismatched restorationsقبل العلاج
Post-treatment frontal intraoral view with redistributed space and level incisal planeبعد العلاج

CASE-033 · Complex Cases

Adult Spacing and Worn Anterior Restorations — Orthodontic-Restorative Interface

المقاربة
Complex Cases
الموجودات
05 مسجّلة
المراحل
05 مخطّطة
Pre-treatment frontal intraoral view showing severe crowding and a blocked-out upper canineقبل العلاج
Post-treatment frontal intraoral view with aligned arches and a level incisal planeبعد العلاج

CASE-034 · Fixed Orthodontics

Severe Crowding with a Blocked-Out Upper Canine and Anterior Edge Wear

المقاربة
Fixed Orthodontics
الموجودات
05 مسجّلة
المراحل
06 مخطّطة

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