Orthodontic care held a fractured bite together after severe cycling trauma
A cycling crash turned a routine orthodontic journey into a test of coordinated trauma care, surgical recovery and dental judgment. Simon Ketteringham had started treatment to improve the alignment of his teeth and his confidence, but a serious accident left him with a fractured jaw, broken ribs, a fractured wrist and a bite that had been forcibly altered by facial injury.
The case is a reminder that orthodontic treatment does not always unfold in a straight line. When a patient’s facial skeleton is injured, tooth movement, occlusion and restorative planning can all be interrupted at once, and the clinical response has to shift from planned alignment to damage control, healing and preservation of long-term options.
Ketteringham had considered orthodontic treatment for years, but a difficult teenage experience with a removable appliance made him reluctant to return to care. The decision changed when his son began treatment and his own dentist recommended Megan Hatfield, an orthodontist at Wetherby Orthodontics in West Yorkshire. After a balanced discussion of the available options, including more complex pathways and their trade-offs, he chose fixed braces and began treatment in April 2024.
Months later, the course of care changed abruptly. Around ten months into treatment, the cycling accident left him with a Le Fort fracture that significantly disrupted his bite. Several teeth were mobile, the braces were damaged with broken brackets and distorted wires, and the future of his front teeth was uncertain. One or two teeth may have been lost, at least initially, because the injury had compromised both the teeth and their supporting structures.
Trauma forced a pause, not a conclusion
The immediate priority was not orthodontic finishing. It was stabilisation.
Ketteringham was airlifted to Leeds General Infirmary, where he received emergency trauma care and jaw surgery. In parallel, Hatfield arranged for the practice to be empty when he returned so the damaged appliance could be assessed and removed safely. She then liaised directly with the maxillofacial team and with Ketteringham to decide how orthodontic treatment could be preserved without interfering with surgical healing.
This is where multidisciplinary dentistry becomes more than a phrase. Facial trauma alters occlusion, soft tissue condition and tooth mobility in ways that can make routine bracket management unsafe unless the hospital team, orthodontist and general dental practitioner are aligned on timing and priorities. In this case, pre-treatment photographs helped the team compare the pre-injury arrangement with the post-trauma anatomy, giving them a reference point for both bite correction and restorative planning.
The damaged appliance was only one part of the problem. Ketteringham also needed dietary restriction, moving from liquid foods to soft foods while he recovered. That kind of limitation affects not just comfort but also how the teeth and jaws function during healing, especially when the bite itself has been disrupted by a maxillofacial fracture.
Healing, then a careful return to braces
Orthodontic treatment resumed only after the surgical phase had taken priority and the clinical teams judged it appropriate to restart. The braces were replaced after surgery, and the team continued to monitor how each tooth responded over time.
The teeth at the front of the mouth needed particular attention. Some required restorative work, including composite bonding, and discolouration would need ongoing review. Retainers would also have to be remade once treatment was complete. Each of those steps reflects a familiar reality in post-trauma dentistry: alignment alone does not restore function or appearance when hard tissue damage, color change and possible instability remain in play.
Hatfield kept in contact with Ketteringham’s general dental practitioner, Sian, throughout the process. That communication allowed the team to balance orthodontic goals with the restorative needs of the injured teeth, and it reduced the chance that one part of the treatment plan would undermine another. In facial trauma cases, the prognosis of individual teeth may remain uncertain for a long period, which means clinicians need to plan for change rather than assume a fixed endpoint from the outset.
Ketteringham described the period after the accident as a blur of injuries, surgery and medication, but he also recalled the support around him. He had visitors during recovery and credited both the hospital team and the dental team with helping him through a difficult stretch. His account reflects a common but rarely visible part of orthodontic care: the psychological value of having a clinician who can explain what is happening, what can wait and what must not be rushed.
The final result extended beyond alignment
By September 2025, the treatment had reached its final stages. The brackets came off and the finishing details were completed, bringing the case to a close after a far longer and more complicated journey than either patient or clinician expected at the start.
The emotional effect of that moment was as important as the mechanical one. Ketteringham had set out to improve his smile, but the finished result arrived only after surgery, uncertainty and a prolonged recovery. He is now back cycling, including a recent trip to Girona, Spain, and he continues to travel around Europe while mentoring younger cyclists.
His front teeth will still need monitoring because trauma can leave a delayed imprint on tooth vitality and supporting tissues. Even so, the outcome restored confidence and normality in a practical sense: he can smile openly in photographs again, and he has already recommended Megan to another person considering orthodontic treatment after relapse following braces in adolescence.
The case earned recognition through the British Orthodontic Society’s Against the Odds award, an acknowledgement of both the clinical complexity and the perseverance involved. Ketteringham said he plans to donate the prize money to Leeds General Infirmary and Yorkshire Air Ambulance in gratitude for the care he received.
Hatfield’s perspective was blunt and clinically grounded. Severe trauma changed the teeth, their supporting structures and the bite, so the plan had to evolve as the injury declared itself over time. The case also showed how orthodontic treatment can sit inside a wider treatment pathway rather than stand apart from it, especially when facial trauma threatens both dental function and the eventual cosmetic result.
For clinicians, the enduring lesson is practical: assess each tooth individually, keep hospital and dental teams in direct contact, and accept that a post-trauma orthodontic plan may need to be revised repeatedly before the final result becomes clear.