Skeletal
MSE in a 24-year-old, suture opened
Bicortical screw placement planned on CBCT after the first plan showed insufficient palatal bone posteriorly. Screws moved 4mm anterior; suture split at day nine.
Case library
Proof, with the reasoning attached.
Every case records what we planned, what changed, and what we would do differently. The one we turned down is in here too, because that decision was the useful part.
Selected work
Twelve cases, start to finish.
Worked examples of how each case type is planned and documented. The illustrations are schematic representations of the workflow, not clinical records.
AllSkeletalOrthognathic
AlignerClass IIApplianceImplantProstheticCombinedMetalDiagnostics
Orthognathic
Bimaxillary advancement, intermediate and final wafers
Le Fort I with BSSO. Intermediate wafer indexed to 1.5mm so it located reliably without binding under drapes.
Aligner
Non-extraction crowding, 6mm lower
Staged with IPR distributed across three phases rather than front-loaded, so anchorage held without a TAD.
Class II
MARA in a growing patient, mixed dentition
Construction bite recorded at the chair; anchorage assessment flagged the lower incisors and a lingual arch was added before fitting.
Diagnostics
Planned versus achieved, one year post-surgery
Superimposition of the surgical plan against the twelve-month record. The chin projection landed 2mm short of plan and we documented why.
Metal
One-piece CoCr expander framework
Replaced a soldered-band design that had fractured twice at the same junction. Printed as a single body, so there was no joint left to fail.
Appliance
Full-coverage stabilisation splint, pre-surgical
Designed at a defined vertical with even bilateral contacts, printed in clear resin and worn for eight weeks before planning.
Skeletal
MARPE declined — bone would not support it
Planning showed cortical thickness below the threshold at every viable screw site. We said no and suggested a surgically assisted approach instead.
Production
Printed models and appliance jigs, batch of twelve
Nested and oriented for the practice's own printer, with base thickness and support contact tuned to their resin.
Diagnostics
Scan rescue on an untrimmed palatal vault
The original scan stopped at the gingival margin, so there was no vault to build a frame on. We specified the re-scan and the case ran clean.
Implant
Guided posterior implant, prosthetically driven
Bone-driven position would have put the screw access through the buccal cusp. Replanned from the restoration back; angle changed 14 degrees.
Prosthetic
Screw-retained molar on a titanium base
Emergence built from the healing abutment scan, with screw access rotated out of the central fossa before the design was approved.
Combined
Ortho then implants — planned as one case
Space opening at 12 and 22 set by the final restoration width, not by whatever the aligners happened to produce. The prosthesis drove the tooth movement.
How we document
A case is not finished when the file ships.
An expander that looked perfect on screen and loosened at week three is a design that was wrong. We only learn that if someone writes down what happened in the mouth.
- The objective — what movement was wanted, and the constraints around it
- The design decisions — anchorage, screw position, indexing depth, staging order
- What changed — every revision and who asked for it
- Chairside reality — seating, fit, adjustment time, anything unexpected
- The lesson — what we would do differently on the next one
Publishing cases
Consent comes first, always
Nothing goes into this library without documented patient consent for the images used, and identifying details are removed as a matter of course. Orthodontic records are unusually identifying — a profile photograph and a ceph together are close to a name. Treat them accordingly.
This is general guidance, not legal advice. Check your own regulator’s rules on advertising and patient imagery.
The entries above are worked examples showing how each case type is documented. Cases from clinical practice replace them as consent and records are confirmed.
Taking new cases
Want your case in here?
Send us something difficult. We will design it, document the reasoning, and you keep the write-up either way.