Protruded Anteriors in the Self-Conscious Adult

Problem

“I have an adult patient who is interested in improving protruded anteriors and closing and accompanying diastema. The lower incisors do not interfere with the proposed movement. The patient is a highly visible professional and desires an appliance that is esthetic. What appliance do other doctors prescribe in this situation and what has been their experience with treatment duration?”

Solution

A simple Modified Hawley Removable Appliance with Hooks is frequently prescribed for anterior retraction on adult patients. Many doctors prefer Modified Hawley Removable Appliances for their adult patients because they are esthetic, require minimal chair time and are effective when worn regularly.

A hook positioned at each cuspid allows the application of an elastic ligature on the labial of the anteriors that provides gentle, continuous movement to the lingual. The patient is instructed to change the ligature nightly for optimum pressure and hygiene.

At each visit, the acrylic is reduced on the lingual on the incisiors only slightly so that the pace of improvement is controlled, thus providing for periods of movement and rest. The adjustment loops on the labial bow are closed periodically as the case progresses. The labial bow will then serve as a fulcrum for rotations and as a guide for final alignment as the anteriors are moved to the lingual.

Treatment duration can vary widely as each patient reacts differently to orthodontic pressure. However, many doctors indicate that simple cases of anterior retraction with existing diastemas providing the needed space are often improved within six to nine months.

After movement is complete, the elastics are discontinued and the loops on the labial bow are adjusted until the wire contacts the labial of the anteriors. The appliance is then worn as a retainer for at least nine months and is re-inserted approximately once each month thereafter as a “check guide” against relapse. If it is difficult to seat, indefinite nighttime retainer wear is usually indicated as a form of splint.