Bill HangDental Practitioner, Lecturer at OrthO2Health

The Case Against Closing Spaces - William M. Hang DDS MSD

18 Feb 2013 · 3 min

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2:31

In this clinical presentation, Dr. William M. Hang recounts the treatment of a teenage female patient who had been in braces for three years and suffered a three‑week headache. He explains how he examined her temporomandibular joints and masticatory muscles, identified that the mandible was constrained by the orthodontist’s use of closing loops intended to retract the anterior teeth, and argued that the prevailing orthodontic dogma of eliminating all interdental spaces was inappropriate. Hang removed the closing loop, which immediately allowed the mandible to reposition, increased anterior spacing, and eliminated the patient’s headaches within days. He uses the case to illustrate the risks of aggressively closing spaces, the importance of respecting natural “primate” spaces, and the value of patient‑centered, symptom‑driven decision‑making in orthodontics.

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Now, here's a girl who's from this area, and she comes to me for a second opinion. Gee, should I have this tooth uncovered or not? She's been in braces for 3 years. She had a 3-week-long headache that's been going on. She never told her mom. And I look in her and I tell her, I palpated her joints, I palpated her muscles, and she went through the roof. She's got this much space right here, and all orthodontists are taught you can't have any spaces, even though we have a primate space. Primates have primate spaces that we learned about, and yet you finish the case, you're gonna get downgraded if you don't close the space. Well, her mandible is already trapped. Her mandible has no place to go, and there's this much space left. And the orthodontist is retracting. And he's got these closing loops in here to do so. You pull the wire back here, bend it up, and this just cranks these back, pulls the front teeth back. There's no space here. There's no overjet. The joints had not started to click. And I said to the mom, I said, forget— yeah, get this uncovered if you wish, but I view this as an emergency situation. I think you need this thing cut out of here right now. I cut it out of here. Cut the closing loop out of here. One week later, the space had increased. Now you're gonna see all the spaces over here. That is when we first saw the patient. One week later and 6 weeks later. Look at the difference in the space right here. Right over here, clear over to here. And nothing was happening except the tongue was pushing the teeth forward. The headaches were gone. I called the patient 2 days— I saw her on a Thursday, I called the house on a Saturday. How are you doing? My headaches are gone, completely gone.