The gap she had lived with since childhood

Before treatment — in their own words

She was fifteen when she came for her consultation, and the first thing she said was that she wanted to make this decision herself. It had been discussed in her family before — her mother had wanted to bring her earlier, but her father thought the gaps were fine, perhaps even charming. She had spent three years listening to people tell her what to think about her own teeth. She had made up her own mind.

The spaces were not new. They had been there since her adult teeth came through, and in the lower arch she was also missing a second premolar on one side, a congenital absence that had contributed to the spacing pattern.

The clinical picture

Multiple diastemata were present in the upper arch, with the largest gap between the central incisors. The lower arch showed generalised spacing, with one sector affected by the congenitally absent lower right second premolar. The bite relationship was Class I with normal overbite and overjet. The lower premolar absence had left the space occupied by a retained deciduous molar in good condition — one that could serve as a long-term placeholder while the plan for that space was finalised.

The upper arch spacing was entirely resolvable by tooth movement alone.

The plan

Upper arch treatment used Invisalign Teen to close the diastemata by moving teeth together from both directions, distributing space closure evenly rather than concentrating all movement in one area. In the lower arch, space was redistributed around the absent premolar site to optimise the occlusion. Attachments provided the retention needed to translate and torque the upper incisors effectively. Compliance was excellent throughout — this was a patient who had chosen treatment for herself, and it showed.

The outcome

Fourteen months after starting, every gap in the upper arch was closed. The lower arch was aligned with the space around the absent premolar ideally distributed. Her bite was stable. She was fitted with a Vivera retainer, with careful counselling about lifelong retention — spacing cases, particularly those involving arch length discrepancy, require dedicated retainer wear to maintain the result.

She sent a photograph from her school graduation. She was smiling in every one.