Starting With Ameloplasty

by Dr. Michel Champagne, BA, DMD, MAGD, IBO, CDE

What are the indications for ameloplasty and why should it be done in most cases at the beginning of treatment.

The clinician should evaluate in all cases if ameloplasty is indicated at the beginning of treatment first to increase the aesthetic output and second to facilitate perfect bracket placement.  If initial ameloplasy is done, the the clinician eye perspective will change and better results can be obtained. The diagnostic phase is done looking at the treatment objectives, treatment plan, case presentation with limitations and compromises that have been presented to the patient and written down in the orthodontic file. It is necessary to explain to the patient why an ameloplasty may be indicated before bracket placement. For future reference and also to have a complete file, it is of the extreme importance to document which surfaces were modified backing it up with pre and post ameloplasty photographs. Do not take any chances and document more than not enough.

If the initial shape of the tooth interferes with good bracket placement, the decision to do the ameloplasty is quite obvious. The clinician must take the time to evaluate both the initial tooth form but also the periodontal status like the height of the gingival contour. We might resume that we must look and resolve all micro esthetic factors that would be more difficult to correct at the end of treatment without extending the treatment time. Waiting the end of treatment to do the indicated ameloplasty may cost you a few months due to the necessity to reposition some brackets or the need to incorporate finishing bends in your wire.

No ameloplasty possible on the upper central incisor but possible on the lowers

Ameloplasty was possible