Monday, November 5, 2007

Blocked out teeth

It is important to create space for blocked out teeth and get them into the arch very early in treatment. I start all my fully bracketed cases in either .014 or .016 nickel titanium archwires. I pack coil (.010x.030 stainless steel) to create space for any tooth that does not have enough space to fit into the arch.
Before I go into the details of packing coil, let's discuss this space creation. When packing coil, space is created by allowing the teeth to move anteriorly in the arch. If you are treating a case non-extraction, you must be willing to accept the fact that space will be gained at the expense of anterior teeth moving forward. For every millimeter that teeth move forward, about 2mm of space will be gained. If you decide to use a non-extraction treatment approach, you must understand and be comfortable with the fact that the anterior teeth will move forward during the initial aligning. If you are comfortable with this forward movement, non-extraction therapy is a good choice.

So, how do you pack coil? Here are the steps.
1. Visualize the arch from an occlusal view. If a tooth doesn't have enough space to fit in the arch form, you need to pack coil in that area.
2. Pack a section of coil that is 2mm longer than the distance between the adjacent brackets. For example, if the lower right lateral incisor is blocked out, pack a piece of coil that is 2mm longer than the distance between the distal of the bracket on the central, and the mesial of the bracket on the canine.
3. See the patient in 4 weeks and evaluate. If the space create can accommodate the tooth, engage the tooth. If the space is not big enough, pack a piece of coil that is 2mm longer than the one previously used.
4. Repeat step 3 until enough space is created.

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