The Cosmetic Challenge: The Class 2, Division 2 Patient Rick DePaul, Jr., DDS
Author, Powerprox Six Month Braces Technique

The class 2 division 2 malocclusion can be a difficult one to achieve a great cosmetic result on. One characteristic of this malocclusion is retroclined upper central incisors. These teeth are also supererupted leading to a deep bite and less than desirable gingival architecture. The lateral incisors are often labially displaced as well (Fig. 1). All of these factors make for a very challenging cosmetic case.

Many patients want quick results. This is one of the great benefits of placing porcelain veneers. You can get a great smile very quickly. Unfortunately, you cannot simply place veneers on the teeth in a division 2 case and get a great result. In order to improve the gingival architecture significant crown lengthening must be performed prior to placing veneers. Many times intentional endodontics must be performed as well due to the labial-lingual discrepancies of the upper incisors (Fig. 2).

The use of orthodontics in these cases can help make these challenging division 2 cosmetic cases easy. My preferred method to treat these cases is the Powerprox Six Month Braces™ technique. This method allows you to quickly and conservatively treat these difficult cases.

Some of the advantages of performing orthodontics instead of porcelain veneers alone on division 2 cases are:

• Orthodontics opens the bite.
• Less need for crown lengthening since you can greatly improve the gingival architecture with orthodontics.
• Less need for intentional endodontics since you are aligning the incisors.
• Less tooth reduction required for your preparations if veneers are going to be placed after orthodontic treatment.
• Makes the “impossible” veneer case “easy.”

The only disadvantage of performing the Powerprox Six Month Braces technique on division 2 cases is the patient will finish with some overjet. The patient must be told of this prior to starting treatment. If that is an issue, the patient is told that comprehensive 2-year orthodontics is the treatment of choice for them. Most patients do not mind having some overjet at treatment completion.

This patient presented for cosmetic improvement of her class 2 division 2 malocclusion. Her chief complaint was crowding of the upper front teeth. Multiple treatment options were presented including porcelain veneers and comprehensive orthodontic treatment. The patient opted for treatment with the Powerprox Six Month Braces technique. The pre-op photos appear in figure 3.

The actual treatment was very straightforward. We bracketed the upper and lower arch. Then, we placed lingual composite build-ups to aid in bite opening, to allow for faster tooth movement and immediate lower arch bracketing. We performed some minor reprox over a couple of visits and ran through an archwire sequence. On this case we used just two archwires: a 014 nickel-titanium and a 16x22 copper-NiTi. The copper-NiTi was placed in the second month of treatment. Our overall treatment time was six months.

Figure 4 shows the 2-month mark. You can really see how much the upper needs to be leveled. Also, look at the curve of the 16x22 copper-NiTi wire.

Figure 5 shows the patient’s dentition immediately following debracketing. We left the patient class 2, just as we would have with a veneer case.

Note the improvement in gingival levels by leveling out the upper arch. This is one of the great benefits of ortho in these cases. The vertical also opened up nicely. If the patient had chipped or worn teeth in addition to a division 2, this would now be a very straightforward veneer case (Fig. 6).

Cosmetic corrections on patients with division 2s do not have to be extremely difficult. These patients can be given great smiles very conservatively and very quickly. The goal of both porcelain veneers and the Powerprox Six Month Braces is the same: to give your patient a great smile. The end destination is the same, only the road taken to get there is a little bit different.

For more details on this case go online to the Dentaltown.com Case Presentation section: http://www.dentaltown.com/gold/case.asp?MemberType=Gold&id=2620

Rick DePaul, Jr., DDS is the author of the Powerprox Six Month Braces Technique, “the next step in the cosmetic dentistry revolution.” He can be contacted at www.sixmonthbraces.com. Dr. DePaul’s seminar is also available for free online at Dentaltown.com/onlinece.