Against the Odds – winning case study

orthodonticsDr Adil Mannan was recognised with the Against the Odds Award when he treated Tatiana Williams. Her winning story perfectly illustrates how orthodontics can change and enhance lives.

This lovely young lady presented aged 23 years old with her mother at The Orthodontic Practice, Battersea, London for an assessment with a complaint about the appearance of her teeth and her peg-shaped UL2. 

Tatiana presented with a class II, division II incisor malocclusion on a mild class II skeletal base. Average Frankfort Mandibular Plane Angle, overjet of 3mm, overbite increased and complete, half-unit class II buccal segment relationship bilaterally, mild crowding in both arches and diminutive upper UL2.

She had no history of previous orthodontic treatment. Although, she had undergone extensive facial surgery and trauma management following a dog attack when she was four years old.

  • Figure 1

Treatment options

We discussed her malocclusion and related dental, soft tissue and facial aesthetic features in some detail.

Options for orthodontic management of her malocclusion were discussed; the option for a joint surgical approach to treatment was discounted. We agreed on possibly having to accept a compromise occlusal end result to treatment. Rather than undertaking extractions that could prove detrimental to the smile and facial aesthetics.

We also agreed on the need for a multi-disciplinary care approach to overall management, with restorative build-up of the UL2 and other anterior teeth, subject to reassessment towards the end of treatment, particularly dependent on adequate space creation.

Tatiana and her mother were keen to proceed and we agreed on fixed appliance treatment for an estimated duration of 18-24 months, using 3M MBT prescription Clarity Advanced brackets/tubes in the upper arch and Gemini brackets/tubes in the lower arch, which would be followed by long term retention with lingual bonded retainers and vacuum-formed essix-style retainers.


  • Figure 8

Upper and lower fixed appliances were placed, including the second molars in each quadrant, over two appointments. Early class II inter-maxillary traction was undertaken, using light forces. Tatiana was highly motivated and grew successively confident and more relaxed as treatment progressed.

Levelling and alignment were achieved quite quickly. We progressed to posted 0.019”x 0.025” stainless steel working archwires seven months into treatment. Heavier class II traction was then utilised to correct the antero-posterior discrepancy. Push-coil was used to open up space mesial and distal to the diminutive UL2 to a total width of 6.5mm. This facilitated the restorative build-up as per the golden proportion.

Approximately 14 months into treatment Tatiana was referred to Dr Zaki Kanaan at K2 Dental Practice in Hammersmith, London. A crown lengthening procedure was undertaken on the UL2. Post-debond planning was undertaken for a no-preparation veneer for the UL2, composite restorations of the U1s and a lower incisor, and bleaching of the dentition.

Active orthodontic treatment was completed in approximately 18 months. The fixed appliances were debonded. Upper and lower canine-to-canine lingual retainers and vacuum formed retainers were fitted.

Five weeks later the above planned restorative work was undertaken and Tatiana was then provided with replacement vacuum-formed retainers to fit over the restorations and she was instructed on long term retainer wear.

A successful treatment outcome and management of Tatiana’s malocclusion in general and presenting complaint in particular was possible due to a thorough assessment and accurate diagnosis, comprehensive orthodontic treatment planning, a multi-disciplinary approach to management, fully informed consent, excellent patient compliance and suitable appliance selection and choice of mechanics.

Patient’s response

Figure 15

Tatiana said at the end of the treatment: ‘It may seem like an insignificant change for some, but being able to see my whole face, not just fixate on the part that has caused me so much pain, is a feeling that I will always owe to Dr Mannan. It took him vision to allow me to even consider braces; without him I do not think I would have found the courage to begin this treatment.

Family and friends have commented on how my overall self-esteem and confidence has greatly improved. This has no doubt all been down to the incredible work that Adil did for me – thank you!’

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