Orthotown January/February 2018 - 24
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splint123
Member Since: 03/03/06
Post: 4 of 24
I would handle this with RPE. Bond upper and open spaces for U3s. Expose and bond UR3.
M room possible need for expose and bond of UL3 but not likely due to its orientation. (I think
opening up room is enough for it to drop in.)
Lower BB and Class II E's. With the obtuse interincisal angle and current lip posture, I
wouldn't be in a hurry to take out teeth, personally. ■
12/7/2017
Fenrisúlfr
Member Since: 02/25/09
Post: 5 of 24
+1. I would expand and advance the upper centrals. Once the teeth are aligned and fully
torqued, you can eval for extractions. ■
12/7/2017
str8nerinva
Member Since: 03/12/08
Post: 6 of 24
So, after expansion you would advance the U1s against the U4s, staying off the U2s-presumably
to minimize the potential for damage to the U2 roots. But at some point the U2s must be moved
mesially to create space for the U3s to have a place to go after exposure. The good news is that when
rotating the CBCT, I can see about 1mm space between the crowns of the U3s and roots of U2s.
One might consider exposure of the U3s during RME stabilization, and tease them posteriorly
with traction from the expander to move them further away from the U2s roots. Then could
advance U2112 against U4s. ■
12/7/2017
Fenrisúlfr
Member Since: 02/25/09
Post: 7 of 24
That could certainly work. I'd try to align the 2s just using single-vector mechanics, as
opposed to intrabracket mechanics, due to the unfavorable couple. ■
12/7/2017
edgewise
Member Since: 06/20/08
Post: 8 of 24
Extract first premolars, expose, bond and erupt the canines. Minimum anchorage on the
lower arch. Can you really expand this patient enough to make space for the upper canines? ■
12/7/2017
ucla98
Member Since: 09/28/07
Post: 9 of 24
IMO, 10+ millimeters of crowding in the upper arch is too much for this mouth to handle;
I think teeth need to be extracted. The molars on both sides look Class I to me. Therefore, I'd
take out all 5s.
The impacted canine spaces will be created by a combination of:
1. Reciprocal extraction space closure (power chain from 6-4)
2. OCS to flare out the upper 2-2. ■
12/7/2017
Fenrisúlfr
Member Since: 02/25/09
Post: 10 of 24
RPE and incisor proclination are still beneficial, IMO, but in hindsight, I think this is definitely
a case that will need extractions. I would also consider all 5s. Non-extraction is unlikely to be
stable, given the significant increase in IC and IM widths. ■
12/7/2017
str8nerinva
Member Since: 03/12/08
Post: 11 of 24
24
Fen, not sure that I totally understand single-vector mechanics concept. In the above pic, it
looks like the archwire is not in the bracket of the UR2 and that there is a power chain UR2-1.
JANUARY/FEBRUARY 2018 // orthotown.com
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