Orthotown January/February 2018 - 20

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Dr-T
Member Since: 05/19/09
Post: 3 of 17

CaraBrace
Member Since: 01/30/12
Post: 4 of 17

Same here. You just have to adjust the occlusion for any balancing side interferences. ■
12/3/2017

I thought about leaving it as-is. But what would you recommend at this stage? Should I go
ahead and extract the upper C's? Should I extract the lower C and D's?
The LL3 is erupting labially. Should I delay treatment? Thank you! ■
12/3/2017

Dr-T
Member Since: 05/19/09
Post: 5 of 17

I would only extract the upper left C. Do you see on the pano that the crown has overlapped
the root of the primary tooth without it resorbing? That is an indication the crown is erupting
either palatally or labially.
The other primary canine roots are resorbing normally. I would continue monitoring tooth
eruption with 3- to 6-month recalls. Do discuss with the parent that the patient may need bicuspid
extraction after eruption of all permanent teeth. If the crowding is severe, you might end up
extracting those transposed bicuspids anyway. ■
12/3/2017

fesdds
Member Since: 05/22/08
Post: 6 of 17

I don't think you "need" to extract anything at this time. You could monitor or be proactive.
Yes, the roots of both UCs are not resorbing much at this point, but the UR3 and UL4 are vertical,
so no immediate worries for me. The exception to this would be if the parents want to speed up
the starting time for braces. ■
12/3/2017

CaraBrace
Member Since: 01/30/12
Post: 7 of 17

Yes, I can see that the upper left C's root is not resorbing, but also the UR5 worries me because
it looks rotated and doesn't seem to have space to erupt. In the inferior arch, the LL3 is palpable
labially and looks like it's going to erupt in an ectopic position. That's why I was thinking about
extracting the deciduous molar.
Also, I was thinking about extracting the lower right deciduous canine, since we were always
taught in school that the deciduous teeth extractions should be performed bilaterally because of
midline deviation. Isn't that right?
And yes, the mother is eager to start treatment as soon as possible. ■
12/3/2017

socoortho
Member Since: 03/21/08
Post: 8 of 17

Is she an orthodontist? Does she have a diagnostic reason to start now? The mother's opinions
only complicate your decision-making. Do not ever let an uneducated parent dictate your timeline,
regardless of the plan.
I think you have plenty of space for all the teeth in those arches. Extracting primary H is
reasonable if you want to do something. ■
12/3/2017

charlestonbraces
Member Since: 06/05/09
Post: 9 of 17

I most certainly would not correct transposition. I would place space maintainer UR5.
I would place an LLHA space maintainer. If the LL3 looks like it will erupt into really bad
gingiva, I would extract LDs and LRC, of course with space maintainer. ■
12/6/2017

CaraBrace
Member Since: 01/30/12
Post: 10 of 17

Thank you! I already explained to the mom that it is too risky to try to correct the transposition
and she is OK with that. As for the space maintainer UR5, I could not place the band on that
molar. As for the lower arch-thank you, that's what I was thinking of doing. ■
12/6/2017

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