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Finishing Orthodontics With Bioclear

by Dr. David Clark Aug 25, 2014 Aesthetics Not tagged yet...

Orthodontics has seen significant advances over the past decade.  In spite of these advances, there is no magic wand or silver bullet when teeth are undersized. In addition, there are a staggering number of adult ortho cases that produce the dreaded black triangle or space between teeth, an aesthetic dilemma that is considered to be more unsightly than the crowding that led to the ortho in the first place. Black triangles come about for a number of reasons- bone loss, recession of the gum line or movement in the teeth. In some cases, the lateral incisors (the teeth on each side of the main incisors) are undersized, having not grown in proportion to the incisors alongside them. In this Part One article, we will discuss undersized teeth.  In Part Two, we will discuss post-ortho Black Triangles.

Bioclear Injection Over-Molding versus “Bonding” 

“Bonding" sounds lot like “Bondo” which is the cheap way to fix a wrecked car fender.  Bonding and Bondo have given composite a bad name.

Fig 1

This patchwork style bonding on the central incisors gives composite a bad name.  Note the excess translucency, small holes full of brown stain, and most importantly an ignorance of the larger issues that could have been addressed if the teeth had received the modern approach outlined in this article.

Go online and read how “Cosmetic Dentistry Experts” tell the public that bonding is inferior to porcelain veneers.   That is due in large part to a flawed system, lack of training, and a dearth of proper engineering principles for composite that leave that case sooner or later to look like poor asphalt patchwork.  The Bioclear approach is not bonding.  It is injection overmolding.  Instead of just patching the tooth, the Bioclear Matrix and method allows the entire tooth to be overmolded with variable thickness composite.  Why perform patchwork when you can routinely pave the whole street?   Properly done, it is superior to porcelain for both black triangles and young post-ortho patients.  This 2 part article  series will first introduce the reader to how the Bioclear matrix and method works to completely injection overmold cases with undersized incisors,  and the next to injection overmold teeth with black triangles.

Double Trouble! Identical Twins with Peg laterals.

Fig 2 Identical twins with undersized teeth and peg laterals.  When compared with the post-operative photographs, these faces seem a little sad and straining to smile.  Most patients hate tooth gapping far worse than dark teeth or crowded teeth.

 At first glance and at a straight facial view, the twins might just look like the need a “little bonding” on the peg laterals.    

Fig 5 Fig 4

Fig 17

However, a closer profile angled look revealed that all of the four incisors were undersized and simply adding to the lateral incisors or even just the four anterior teeth would produce inappropriately sized teeth.  With the Bioclear method, “bonding to hide gaps” in my practice has evolved to” 360° composite overmolding” for a strong, predictable and permanent solution.

After a discussion with the treating orthodontist, the ideal treatment of over-molding teeth #’s 6, 7, 8,9,10 and 11 was agreed upon with the two patients, parents, and orthodontist. 

The Treating Orthodontist’s View:  “A tooth size discrepancy caused by narrow maxillary lateral incisors is a very common problem faced by orthodontists.   Changing the tip and torque of the maxillary incisors or reducing the mesial distal dimensions of the lower incisors can often solve the discrepancy without the need for future maxillary restorations.  However, when the discrepancy is large, as was the case with these twin sisters, restorations are a necessity.  Determining the exact position to place the maxillary lateral incisors can be difficult, especially when working with various restoring dentists, each with different professional opinions.  What impressed me the most about using the Bioclear Matrix method was the ability to modify the shape more apically on the mesial and distal aspects of the incisors, thereby changing the emergence profile and giving more flexibility for the position of the teeth.  When discussing where to place the lateral incisors orthodontically, Dr. Clark was less concerned about their exact position than I was, and yet his results were excellent.”  Dr.Jerrold S. Johnson

Fig 21 1

The two girls after the Bioclear procedures

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