Clinical Case Spotlight: Nonsurgical Underbite Treatment by Drs. Anthony D. Viazis and Evangelia Dartzalopoulou

View Comments (7)

Categories: Cosmetic Dentistry; Orthodontics;

Clinical Case Spotlight: Nonsurgical Underbite Treatment

Treating a patient’s complete underbite in centric occlusion—using only Fastbraces brackets and one archwire, in 256 days

by Drs. Anthony D. Viazis and Evangelia Dartzalopoulou

The treatment presented here is that of a 19-year-old patient with a complete underbite in centric occlusion from the right first molar all the way around to the left one (Figs. 1a–1c). He was treated by the first author in her general dental practice without orthognathic surgery, palatal expanders or extractions, in 256 days, using only Fastbraces brackets and only one square wire from start to finish in each arch. (Intraarch elastic power chains were used to close spaces or rotate teeth efficiently, and interarch vertical elastics were used throughout the treatment.)

Fig. 1a

Fig.1b

Fig.1c

Fastbraces Technologies’ patented bracket systems include three slots for archwires—the main slot, a gingival slot and an incisal one. The Fastbraces brackets’ unique elbow design constantly changes the equation of the wire flexibility as the teeth move. This allows for orthoeruption, or the uprighting of displaced roots into a straight position as if the tooth erupted in that position naturally, in a matter of 90 days as the initial movement of this case indicates. This, in turn, affects the morphology of the alveolar bone around the malaligned teeth.

A balance between light pressure and tension is the foundation of Fastbraces treatments, which deliver low forces with minimal discomfort to the patient.

Treatment progress
September: The treatment began with brackets and wires in the upper and lower arches, along with bite blocks on the lower first molars to open the bite. A power chain was placed in the upper arch between the two central incisors, to close the space between them, and another power chain from the first molars to the canines on either side to retract the canine teeth. The upper lateral incisors were laced to the main wire with a ligature wire to keep them in place while the canines were retracted (Fig. 2). Root torque from the square wire in the slot of the brackets facilitates the remodeling of the alveolar bone from the onset of therapy.

Fig. 2

November: The bite blocks were removed after about 60 days into the treatment because they were no longer needed. The wire was placed in the incisal slot of the upper central incisors for labial crown torque of all these teeth to secure a positive overjet. The patient was given elastics to wear in a triangular shape from the upper canine to the lower canine and the lower first premolar (Figs. 3a–3c) on both sides 24/7.

Fig.3a

Fig.3b

Fig.3c

January: The wire was placed in the gingival slot of the lower left canine bracket to extrude this tooth. The patient made good progress closing the open bite with the vertical elastics in the canine area (Figs. 4a–4c) and was encouraged to continue to do so with better oral hygiene.

Fig.4a

Fig.4b

Fig.4c

February: The brackets were placed upside-down on both upper lateral incisors to torque their roots more labially. In addition, the wire was placed in the incisal slot of the brackets on both upper first molars to torque their crowns more buccal. The upper canine brackets and the lower left canine bracket were rebonded more incisally (Figs. 5a–5c).

Fig.5a

Fig.5b

Fig.5c

Early March: In the upper arch, the wire was placed in the gingival slot of the upside-down brackets on the lateral incisors to make the roots move more labially even faster. In addition, the wire was placed in the incisal slot of the upper right first molar, the upper left second premolar and the upper left first molar to torque their crowns more buccally (Figs. 6a–6c).

Fig.6a

Fig.6b

Fig.6c

Mid-March: The wire was placed in the main slot of the upside-down brackets of the upper lateral incisors and in the incisal slots of the upper first molars. The lower wire was placed in the gingival slot of the lower right first premolar to extrude the premolar tooth (Figs. 7a–7c).

Fig.7a

Fig.7b

Fig.7c

End of March: In the upper arch, the wire was placed in the gingival slot of the upside-down brackets of the lateral incisors once more. The central incisors were laced to the canines on either side to prevent the lateral incisor crowns from moving more incisally while their roots moved more labially. The wire was placed in the main slot in the upper first molars. In the lower arch, the teeth were laced with a ligature wire from the first molars to the laterals on both sides. Interproximal reduction (IPR) was done between the four lower incisors and a power chain was placed from the right lateral to the left lateral to retract them (Figs. 8a–8c).

Fig.8a

Fig.8b

Fig.8c

April: In the lower arch, IPR was done from the right canine to the left canine. The canines were laced to the first molars on either side and a power chain was placed from the right canine to the left canine to retract the incisors a bit more. In the upper arch, new brackets were placed on the lateral incisors and the wire was then placed in the incisal slot of the canines to torque their crowns more labially (Figs. 9a–9c).

Fig.9a

Fig.9b

Fig.9c

Early May: All the teeth in the lower arch were laced molar to molar. In the upper arch, the brackets of the right and left first molars were removed and the premolars were laced (Figs. 10a–10c).

Fig. 10a

Fig.10b

Fig.10c

End of May: Final visit (Figs. 11a–11c and 12a–12b). Lingual fixed retainers were cemented from canine to canine in both arches.

Fig. 11a

Fig.11b

Fig.11c

Fig. 12a

Fig. 12b

Author Bios

Dr. Evangelia Dartzalopoulou, a general dentist, practices in Thessaloniki, Greece, and received her dental degree from the Aristotle University of Thessaloniki Dental School.

Dr. Anthony D. Viazis, the founder of Fastbraces, is a Dallas-based orthodontist. Viazis holds dental degrees from the University of Athens and at Baylor College of Dentistry, and earned a Master of Science and his graduate certificate in orthodontics at the University of Minnesota (UMN). He has held academic faculty positions at UMN, Baylor and the University of Southern California, and also served as a visiting professor at the University of São Paulo.

View Comments (7)

September 2025

Read Current Issue Read Archived Issues

Subscribe / Renew

	Cutting through the clutter, our new AI-powered summary feature harnesses the power of Artificial Intelligence to condense marathon message board discussions into snappy summaries. Now, at the top of every topic page, with at least 100 replies, you will see a new "View Summary" button. Click that button to got to our new topic summary page, because who has time for endless scrolling when you can get the bite-sized brilliance at a glance?	03/11/24



	We're super exited to announce another small feature to enhance your site experience - YouTube embedded videos. Now, any YouTube video you put into your post will automatically be viewable within the post itself. No longer will a link redirect you to YouTube, rather you can simply watch YouTube videos directly from within your posts. You're welcome!!	03/09/24



	We like nothing better than giving you more freedom and ease when using our site. To that end, we just added a new "Quick Reply" section at the bottom of the thread view page. We did this to give you a fast, simple way to quickly reply to a thread. However, don't expect all the bells and whistles on this new Quick Reply feature. It's designed for speed and ease vs complex functionality.	07/25/23



	To help you stay better connected with the topics you're interested in, we expanded our notification system to notify you when an inactive thread that you've participated on becomes active again. These New Activity emails are sent when there is new activity on a topic that has been dormant for 30 days or more. Of course, as with all our other notifications, you can opt out of this new feature from your Profile page if you don't want to receive these emails.	06/28/23



	They say perfection is in the details, that's why we like adding even small features to our site to make a more robust user experience. In our latest update we expanded on our "Thumbs Up" message board feature (indicating you liked a post), to allow members to also give a "Thumbs Down" to posts. Thumbs up and thumbs down are a feature found on many online communities and social media sites. This is a quick easy way to express your like or dislike of content, creating opportunities for you to have a more personalized experience.	06/22/23



View All

What's Current

Popular Categories

Current Issue

Featured Articles

Recently Added Courses

Popular Categories

Most Recent Podcasts

New Podcast Episodes

Recent Classifieds

Classified Categories

Townie Choice Awards

2024 Results By Category

Latest News

Townie News Wire

Most Recent Blogs

New Blog Posts

Upcoming Events

Townie Webinars

Free e-Books

Monthly Townie^® Polls

Townie Perks

Clinical Case Spotlight: Nonsurgical Underbite Treatment by Drs. Anthony D. Viazis and Evangelia Dartzalopoulou

Treating a patient’s complete underbite in centric occlusion—using only Fastbraces brackets and one archwire, in 256 days

September 2025


Reflecting on Life Interrupted and the Unseen Scars of Grief
	Dr. Parul Dua Makkar
	Health, Wellness and Erg...


The Essential Try-In Acceptance Appointment
	Dr. Leif Stromberg
	Prosthodontics


Introduction to OSA and Dental Sleep Medicine
	Dr. Stephanie Dennison, ...
	Sleep Medicine

	Flow at the Show
	Jeff Price with Dentaltown on Flow Xray Products

Popular Categories

Classified Categories

2024 Results By Category

Clinical Case Spotlight: Nonsurgical Underbite Treatment by Drs. Anthony D. Viazis and Evangelia Dartzalopoulou

Treating a patient’s complete underbite in centric occlusion—using only Fastbraces brackets and one archwire, in 256 days

September 2025

Sign up for Newsletter

Message

Error

What's New?