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The Initial Challenge
The patient first attended our practice as a primary school student in 6th class. She was extremely self-conscious about the appearance and shape of her teeth, completely refusing to smile in family photographs due to structural issues and prominent white spot lesions (enamel hypoplasia) on her front teeth.
A clinical examination by Orthodontist Claire O’Sullivan revealed a complex combination of orthodontic and general dental needs:
- Bite Discrepancy: A severe Class II structural relationship with a deep bite and inwardly tipped (retroclined) lower front teeth.
- Missing & Misaligned Teeth: A missing lower left molar, significant lower spacing, an upper midline shift to the left, and severely tipped adjacent molars.
- Enamel Vulnerability: Molar Incisor Hypomineralisation (MIH) on her lower right first molar—a condition causing fragile, poorly mineralised enamel with a guarded long-term prognosis.
A Bespoke, Multidisciplinary Treatment Programme
To give the patient a beautiful, healthy smile while addressing her enamel vulnerabilities, our specialist team designed a coordinated, multi-stage treatment plan.
Phase 1: General Dentistry Foundation
Before moving any teeth, we prioritised stabilizing her dental health. Dr Kelly Reis restored the structurally compromised MIH molar with a high-durability composite restoration. The patient was also given targeted dietary coaching to swap highly acidic sparkling water for fluoridated tap water to safeguard her fragile enamel.
Phase 2: Invisalign with Mandibular Advancement (MA)
To correct the severe jaw mismatch and deep bite comfortably, the patient chose Invisalign Clear Aligners with Mandibular Advancement. This advanced technology uses specialized wings on the aligners to gently guide the lower jaw forward. The patient was highly cooperative, advancing through over 40 sets of custom-made aligners while utilizing night-time elastics to safely coordinate her bite.
Phase 3: Precision Hybrid Alignment
To masterfully rectify the heavily tipped lower molars around the missing tooth space, our team transitioned the patient to a short, precise phase of lower fixed braces. This hybrid approach allowed us to upright the tipped teeth and perfectly coordinate the upper and lower arches before de-bonding.
Phase 4: Cosmetic Refinement & Retention
Following the completion of her orthodontic alignment, the patient and her mother sought to perfect the shape of her upper front teeth. Our team coordinated a cosmetic consultation with Dr Stephen Taylor for composite bonding, artfully contouring the uneven enamel edges to create a symmetrical, seamless smile line.
To preserve this incredible transformation, custom-moulded upper and lower Essix retainers were delivered for long-term night-time wear.
The Long-Term Result: Radiant Health in 2026
In May 2026, the patient attended her routine dental check-up with Dr Emmet Ryan. Her updated X-rays and clinical examination revealed a flawless report: excellent oral hygiene, exceptionally healthy gums, and completely stable orthodontic alignment. From hiding her teeth in photos to confidently maintaining a healthy, radiant smile, this patient’s journey embodies the premium level of care we strive for at Dublin Orthodontist.
The Specialist Advantage: Complex cases involving missing teeth, fragile enamel (MIH), and severe bite discrepancies require a team that can seamlessly bridge the gap between orthodontics and cosmetic dentistry. By choosing a specialist practice, this family received a continuous, expert standard of care from childhood into young adulthood.
Start Your Journey to a Confident Smile
If your child is hiding their smile or struggling with complex alignment issues, early specialist guidance can make all the difference. Our Dublin team is here to design a comfortable, tailored treatment plan that delivers lasting confidence.
