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The Challenge: Severe Crowding and a Deep Bite
The patient first presented to our practice in the mixed dentition stage, unhappy with the alignment and straightness of their teeth. A detailed initial assessment by Orthodontist Claire O’Sullivan revealed several significant structural and dental hurdles:
- Skeletal Misalignment: A Class II jaw relationship with an incredibly deep bite and inwardly tipped (retroclined) lower front teeth.
- Severe Crowding: Insufficient arch space for adult teeth to erupt naturally, alongside an asymmetric dental midline.
- Active Cavities & Enamel Risks: Early signs of tooth decay across multiple molars and generalised plaque accumulation that threatened their overall oral health.
The Comprehensive Three-Phase Treatment Programme
To deliver a stable, beautifully balanced smile, our specialist team created a highly coordinated, long-term plan divided into three distinct phases.
Phase 1: Twin Block Orthopaedics (Growth Guidance)
We began treatment using custom-moulded Twin Block appliances. These specialised removable blocks work in harmony with a growing patient’s jaw, gently expanding the arches and guiding the lower jaw forward to correct the deep bite. Despite some initial challenges with appliance maintenance, our team supported the family with intensive hygiene coaching, successfully achieving optimal arch expansion.
Phase 2: Strategic Extractions & Fixed Braces
Once the jaw foundation was expanded, the remaining structural crowding needed to be addressed. Following a precise orthodontic review, the patient was referred to our dental team for the comfortable, strategic extraction of four premolars.
Immediately following this, fixed metal braces were bonded to align the teeth, close the extraction spaces, and correct a lateral open bite. Throughout this phase, our orthodontic therapists carefully managed the patient’s bite alignment using specialised latex elastics. The braces were successfully de-bonded in June 2023.
Phase 3: Comprehensive Restorative Care & Joint Maintenance
Because the patient had a naturally high risk of tooth decay, our general dentist, Dr Daniele Ryan, worked hand-in-hand with our orthodontic team throughout the entire journey.
- Targeted Restorations: Dr Ryan placed seamless, tooth-coloured composite fillings on compromised molars and utilised advanced cavity-preventing fissure sealants on newly erupted adult teeth.
- Managing Jaw Clenching: In late 2024, Dr Ryan identified bilateral masseter muscle hypertrophy (enlargement of the jaw muscles), indicating a habit of clenching or grinding. The patient was coached on the vital importance of wearing their custom Essix retainers, which successfully protected the teeth from premature wear and stabilised the jaw joint.
The Long-Term Result
By December 2025, the patient’s transition was complete. At their routine follow-up, the clinical team noted beautifully stable alignment, healthy gums, and fully restored teeth. Through the patience of the family and the collaborative expertise of our orthodontic, surgical, and dental hygiene teams, this patient now possesses a spectacular, highly functional smile built to last.
The Specialist Advantage: Complex dental journeys require more than just moving teeth. By choosing a multidisciplinary practice like Dublin Orthodontist, this patient received seamless care that protected their teeth from decay, corrected their jaw development, and safeguarded their smile against the real-world effects of teeth grinding.
Start Your Family’s Smile Transformation Today
Do you want to learn how interceptive orthodontics can guide your child’s smile into perfect alignment? Our specialist-led team is dedicated to providing comfortable, world-class care for patients of all ages.
