Orthotown May 2019 - 19
You said the upper centrals are 10mm, that means upper laterals should be 8mm at least. So
right there 2 mm of the space should be gone to bonding. The upper laterals look as wide as the
lower laterals. So my guess is with some lower IPR and aesthetic bonding/veneers of the upper
laterals, this case would come out looking alright. Careful control to shift the upper midline
should be done; I would move one tooth at a time to make sure I got it right. n
3/11/2019
I think there's way more going on here besides the supernumerary. He is very asymmetric,
with a big cant to the occlusal plane, down on the left. The rami are asymmetric in both width
and height.
He is Class 3 left, so that's going to complicate correction of the supernumerary, as there's not
going to be enough OJ, even with lower IPR and planning for veneers. I guess I would wonder
if he really even wants this corrected? How did he get to this age with the supernumerary still
there? Did he just come to see you because his (new) dentist said he should? n
dhmjdds
Member Since: 11/16/04
Post: 3 of 8
3/11/2019
I see your points about the smile cant. But I think this pan needs to be retaken. I think the
head was turned some, the molars on the right appear larger than on the left. So I think there
was some positioning issues prior to the pan.
There may be some skeletal asymmetry, but on the ceph there is no large discrepancy
between left and right borders of the mandible, which is common when there is a mandibular
asymmetry? n
justinudm
Member Since: 09/29/14
Post: 4 of 8
3/11/2019
Thank you for the suggestion, I will retake the pan. I was also surprised that nothing has
been done with the supernumerary until now. I will discuss his expectations again since I am
concerned about the canted plane correction as well. n
3Mortho
Member Since: 11/18/07
Post: 5 of 8
3/12/2019
I would extract the more mesial UL2 as it appears to be narrower than the distal one,
complete lower interproximal sanding. Offer a TAD UL3 area to minimize occlusal cant. Discuss
possible DDS restorations to widen maxillary laterals after treatment if needed. n
srensch
Member Since: 03/12/09
Post: 6 of 8
3/23/2019
What happened next?
This Townie received lots of good advice
and learned from others' experience
with similar cases. If you have any
questions for "3Mortho" or would like to
share your thoughts on the case, go to
orthotown.com/magazine and find this
thread among this month's featured
message boards.
orthotown.com \\ MAY 2019
19
http://www.orthotown.com/magazine
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Orthotown May 2019
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