Case study: crowding that returned twenty years after braces

The concern

The lower front teeth had overlapped again, one sitting noticeably forward of the line. The patient was less troubled by the look than by the feeling of having wasted two years in braces as a teenager, and wanted to know whether it would simply happen again.

What we found

Textbook relapse. Retainers had been provided at the end of the original treatment and worn for perhaps a year. Teeth drift throughout life, faster in the lower front, and without retention the original crowding gradually reasserts itself.

Hygiene was suffering where the teeth overlapped, with early gum inflammation on the crowded surfaces — a health reason to treat, not only a cosmetic one.

The plan

• Hygiene therapy first to settle the gums before any movement
• Aligners over five months, with minimal interproximal reduction to create the space needed
• Home whitening once the teeth were aligned and cleansable
• A bonded retainer behind the lower front teeth, plus night-time removable retainers on both arches

The outcome

Alignment restored in under half a year, with gum health improved because the surfaces could finally be cleaned. The important part of this case is the retention: the fixed wire is checked at every hygiene visit, and the patient understands it stays for good.

Details anonymised. Suitability for aligners and for interproximal reduction is assessed individually.