
To help you achieve optimal results, the Aligner Dental Academy shares its top tips for managing anterior spacing cases with Invisalign.
We have all had that patient who has come in with that awkward space between their front teeth. Anterior spacing has become an increasingly common concern among dental patients today. Fortunately, with advancements in clear aligner treatment, addressing these gaps has become a more direct and minimally invasive solution.
When treating such cases, it is crucial to follow a structured and methodical approach.
Below are the key steps and considerations to guide you through the process:
Preliminary assessment: why does this patient have spacing?
- Localised versus generalised spacing: firstly, assess, is the spacing localised or generalised? If localised, ensure there are no underlying issues such as supernummaries or unerupted canines that could impact treatment planning
- Evaluate Tooth Size Discrepancy (TSD): identify any discrepancies in tooth size. These often present as small upper lateral incisors but can also involve teeth that are generally too small for the mandibular or maxillary arch. Understanding the TSD will influence your treatment plan
- Assess periodontal status: for adult patients, upper arch spacing may result from other factors such as periodontal disease causing tooth migration. Complete a routine check-up to assess for any active periodontal disease and always include X-rays to assess the bone support.
Treatment planning options
For spacing cases, consider the following three approaches based on the patient’s needs and clinical presentation:
- Full closure with retraction
- This approach often aligns with patient expectations as it fully closes the spaces without further restorative work. However, excessive retraction can lead to reduced lip support, causing the smile to appear ‘hidden’ behind the lip. As a rule of thumb, anticipate about 0.75mm of lip drop for every 1mm of retraction planned
- Occlusion considerations: Retraction of the upper anterior teeth usually necessitates retraction of the lower anterior teeth to maintain a functional occlusion. Be cautious with skeletal Class III patients, as lingually inclined lower anterior teeth may complicate retraction and hinder success with this option. If there is not space in the overjet to retract you can consider an ortho restorative approach
- Partial space closure with restoration
- For significant TSD cases consider partial space closure. This involves retraction and/or mesialising to arrange the teeth ideally for restorative work such as veneers or bonding
- Creating symmetry: sometimes, simply reducing and evening out the spaces is enough to deliver a beautiful smile. Invisalign’s precision makes it particularly effective for this
- Accepting space
- In some cases, patients may wish to maintain a specific space, such as a midline diastema, for aesthetic reasons. It’s important to discuss this preference during the planning phase to ensure alignment with the patient’s goals. Invisalign can precisely position the teeth around the retained space to achieve the treatment goals.
Retention strategies
Spacing cases require robust retention to maintain the results:
- Bonded retainers: recommend bonded retainers to provide consistent stabilisation
- Vivera retainers: advise the patient to use Vivera retainers for added retention
- Lifelong commitment: educate patients about the necessity of excellent retention for life and ensure they are committed to this before starting treatment.
By following these guidelines and tailoring the approach to each patient’s unique situation, you can achieve predictable and aesthetically pleasing results for upper anterior spacing cases with Invisalign.
Want to learn more about treating spacing cases with Invisalign?
Join ADA mentor and specialist orthodontist Dr Montse Galliano on Wednesday 29 January at 8pm for our first live webinar of 2025.
💡 What you’ll learn:
✅ Effectively plan and manage spacing cases using Invisalign
✅ Enhance skills in assessing and identifying cases ranging from simple to complex
✅ Understand key factors when setting treatment goals and planning treatment
✅ Learn practical approaches through case reports.
This article is sponsored by the Aligner Dental Academy.