Initial situation
- Tooth shape and size discrepancies, including those related to the Bolton index, were part of the presentation addressed by treatment.
The case was reviewed retrospectively as part of ongoing analysis of results and identification of areas for improvement.
The decision
Temporary restorations were used starting at the tooth alignment stage to restore tooth shape and size, improve function, create proper interdental contacts, and compensate for tooth-size discrepancies related to the Bolton index. This approach also allowed the patient to visualize and get used to the future smile before treatment was completed.
Showing patients their future smile through temporary restorations, rather than only explaining it, helps them commit to the treatment outcome.
The result
Restorations placed during the alignment stage restored tooth shape, size, and interdental contacts, supporting both function and esthetics as part of the overall treatment outcome.
Introducing temporary restorations during the alignment stage, rather than only at the end of treatment, helps patients visualize the final result and can improve case acceptance and communication.
About skeletal expansion & MARPE
Tooth-size discrepancies, quantified through tools like the Bolton index, sit at the intersection of orthodontics and restorative dentistry, and addressing them well often requires coordinating both disciplines from early in treatment. In cases like this, clinicians typically identify shape and size mismatches during diagnosis and decide how much of the correction should come from tooth movement versus restorative build-up. Introducing temporary restorations earlier, rather than waiting until finishing, can also improve patient communication and buy-in throughout the process.
Questions clinicians ask
Why are restorations important in orthodontic treatment, beyond esthetics?
Restoring tooth shape and size improves function, creates proper interdental contacts, and helps compensate for discrepancies such as those related to the Bolton index.
Why were temporary restorations placed during the alignment stage rather than at the end?
Placing them early lets the patient visualize and get used to the future smile before treatment is finished, which supports communication and case acceptance.
What is the Bolton index and why does it matter here?
It is a measure of the size relationship between upper and lower teeth, and discrepancies in it can be compensated for through restorative changes in tooth shape and size.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
