Orthotown April 2023 - 22

MESSAGE BOARD 1
ucla98
Post: 5 of 11
2/15/2023
It's a full-step Class II on the right side. If you
extract an LR5, overretracting of the LR3 is unavoidable
and you will end up with a Class II canine on
that side, even if you can ideally retract the UR3
without losing any posterior anchorage.
So I wouldn't take out any tooth on the LR side.
I would extract both upper 4s and the lower left 6
(because of failed endo), and retract the LL3 just
enough to allow the crowded lower incisors to
align and not to shift the lower midline too far to
the left. If I can't close the 6 space all the way, I just
ask the GP to put a PFM crown on the smaller LL7,
and hopefully the LL8 will erupt and function as a
second molar. n
Brbraces
Post: 9 of 11
2/18/2023
UCLA98's post is what I would present to the
patient. In cases like this (especially with a completely
blocked-out tooth), the first question I will
get from the patient is, " Why not extract the tooth in
the back (aka UR2)? Won't it be faster? "
I, the orthodontist, want ideal and I have no intention
of taking shortcuts. But at the same time, I
can see their side, and with some enameloplasty
UR3, and discussion/awareness that UR4 will not
be exactly identical to UL3 (asymmetric gingival
architecture, crown/tooth size discrepancies, etc.),
it could be a reasonable option (along with the
UL4/LL6 extractions).
Do any of you bring up UR2 ext as an option in
your discussions? Or is it align UR2 only? n
dhmjdds
Post: 6 of 11
2/16/2023
Yeah, that's my bad for not waiting for more complete
records. I agree that ext of LR5 is not appropriate,
due to the full-cusp Class II on the right.
Ext U4s, LL6, maybe keep LL8 (but lower 8s are so
unpredictable-hate to make her go through a second
procedure when LL8 doesn't erupt well). n
socoortho
Post: 10 of 11
2/18/2023
You bring up an excellent point. Additionally, I
would say there is a better-than-even chance that
the future periodontal condition of #6 (in the #7
position) will be better than if #7 is moved into the
correct position, although in a young person, it may
not be as significant. n
emac
Post: 7 of 11
2/16/2023
Agree with UCLA98 on the extractions. Curious
if the patient has been in ortho before? It looks
like there are remnants of bracket adhesive on the
models. If the patient has, I always want to know all
about why they stopped. n
dhmjdds
Post: 11 of 11
2/21/2023
Her UL2 is nice and wide, so I also think extracting
UR2 instead of UR4 could be an option. That
would help shorten treatment time as well-always
a good thing with adult patients. Good thought! n
mk2162
Post: 8 of 11
2/16/2023
No, she was not. We indirect bond, and that is just
the residue after the brackets were removed. Thanks
for the input. n
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