Dr. Rohit C.L. Sachdeva, and Drs. Takao Kubota and Kazuo Hayashi discuss management of space closure in patients requiring extraction therapy.
The purpose of this article is to discuss the application of SureSmile© technology1-6 in managing space closure in patients requiring extraction therapy. Strategies to optimize the use of SureSmile prescription archwires and various Clinical Pathway Guidelines (CPG) developed by the first author (Sachdeva) to manage space closure are discussed.
These are highlighted with patient histories where possible.
Space closure with SureSmile
Efficient and effective management of patients requiring extraction therapy requires proactive care planning, the appropriate choice and design of appliances driven by sound biomechanical principles, and the vigilant follow-up of the patient during treatment based upon a well-designed clinical protocol.
When using SureSmile, two clinical strategies are generally considered in closing the extraction space, namely:
Type 1- Space Closure with SureSmile
The first involves achieving sufficient alignment and overbite correction with conventional mechanics followed by closing the majority of the residual space with sliding mechanics on a SureSmile archwire (Type 1). An example of this is shown in the treatment of patient A.S. (Figures 1-6). With proper consideration to the design of the slideline* in a SureSmile archwire, one can plan to move teeth over a long span with no collision between an archwire bend and bracket (Figure 4).
Type 2- Space Closure with SureSmile
The second strategy (Type 2) involves using conventional mechanics to close the majority of the space followed by using SureSmile wire. The choice of the space-closure device is driven by the nature of malocclusion and the anchorage requirements. The appliance types that a clinician may use to achieve space closure are numerous. However, a prime consideration in their use is driven by anchorage considerations, the desired nature of tooth movement, i.e., controlled tipping or translation (Table 1), and patient cooperation. The relative effectiveness of various space closure devices used by the first author (Sachdeva) in controlling tooth movement during orthodontic space closure is provided in Table 2.
Furthermore, it must be appreciated that timely and effective care of a patient with SureSmile technology warrants avoiding any reactive care processes. One approach to keeping the patient “on-track” is to establish and follow clinical protocols. The first author (Sachdeva) has developed a number of guidelines to clinically manage extraction patients with SureSmile (Tables 3-5). These protocols are driven by the nature of the presenting malocclusion and anchorage requirements. It must be recognized that these CPGs provide a general framework for managing the course of patient care, and a clinician may need to deviate from the pathway at times to cater to the prevailing circumstances and the patient’s response.
Patient I- A.S. (Space Closure Protocol A CPG- Sachdeva )
Patient A.S. presented with a Class II canine and Class I molar respectively with a deep bite and minor upper and lower crowding with retained upper E’s, missing upper right 5, and ectopic erupting upper-left first bicuspid. Based upon the treatment plan, it was decided to extract the retained E’s and upper left second bicispid and treat to a Class I canine and Class II molar relationship respectively.
Patient II- T.Y. (Space Closure Protocol C CPG- Sachdeva )
Patient T.Y. presented with a Class I malocclusion with severe upper and lower arch crowding. Based upon the treatment plan (Figures 7B and 8B1), it was decided to extract the upper and lower first premolars and treat the patient to a Class I with “A” anchorage
The treatment protocol for patient T.Y. was very closely adhered to as shown in the Protocol C CPG (Table 5), and the duration of treatment for this patient was 11 months.
SureSmile technology, when used appropriately within the framework of the clinical pathway guidelines developed by Sachdeva, offer a unique approach to providing both efficient and effective treatment of Class I patients requiring extraction therapy.
Future articles will provide more clinical patient histories to demonstrate the benefits of using SureSmile technology in improving patient outcomes, providing it is driven by a skilled clinician who is willing to follow a proactive care approach to managing patients.
*Slideline is the length of the straight segment between the teeth in a SureSmile archwire along which a tooth may slide uninterruptedly.
The authors are most grateful to Con Vanco, BDS, D Clin Dent, M Orth RCSEd, MRACDS (Ortho), FRACDS, from Adelaide, Australia, for sharing records of Patient A.S. for this paper.
The authors also wish to thank Sharan Aranha, BDS, MPA, for the invaluable assistance she continues to provide in the preparation of this series of articles.
1. Sachdeva R. BioDigital orthodontics: Designing customized therapeutics and managing patient treatment with SureSmile technology: part 2. Orthodontic Practice US. 2013;4(2):18-26.
2. Sachdeva R. BioDigital orthodontics: Diagnopeutics with SureSmile technology: part 3. Orthodontic Practice US. 2013;4(3). 2013;4(3):22-30.
3. Sachdeva R. BioDigital orthodontics: Outcome evaluation with SureSmile technology: Part 4. Orthodontic Practice US. 2013;4(4):28-33.
4. Sachdeva R. BioDigital orthodontics: Planning care with SureSmile Technology: Part 1. Orthodontic Practice US. 2013;4(1):18-23.
5. Sachdeva R. BioDigital orthodontics: Management of Class 1 non–extraction patient with “Fast–Track”©– six month protocol: Part 5. Orthodontic Practice US. 2013;4(5):18-27.
6. Sachdeva R, Kubota T, Hayashi K. BioDigital orthodontics: Management of Class 1 non–extraction patient “Standard–Track”©– nine month protocol:
Part 6. Orthodontic Practice US. 2013;4(6):16-26.
7. Burstone CJ. The segmented arch approach to space closure. Am J Orthod. 1982;82(5):361-378.
8. Fontenelle A. Challenging the boundaries of orthodontic tooth movement. In: Sachdeva RCL, ed. Orthodontics for the Next Millennium. Glendora, CA: Ormco Publishing; 1997: 248.
9. Sachdeva R, Bantleon H. Cantilever based orthodontics—biomechanical and clinical considerations. In: Sachdeva RCL, ed. Orthodontics for the Next Millennium. Glendora, CA: Ormco Publishing; 1997.