Orthotown July/August 2024 - 14
A VOICE IN THE ARENA
Figs. 4-7
In my opinion, based on the level of crowding,
Figs. 8-14
the shape of the upper incisors, their inclination
and their A-P position within the patient's face
(see side smiling photo), the maxillary arch
would ideally be treated non-extraction for my
treatment goals. Just because the upper arch can
be treated non-extraction does not always mean
that it's possible in the lower arch, however, and
interarch coupling/occlusion needs to be an
important consideration. Periodontal tolerance
to non-extraction in the lower arch was my main
concern in considering non-extraction treatment
and surely the reason why many would choose
to treat this case with extractions (which would
definitely be a reasonable plan depending on
treatment goals).
There were, however, several factors that made
me consider not extracting in the mandibular
arch. The lower arch shape was very narrow
in the premolar area relative to the maxillary
premolar area, which was quite wider. (The lower
left first bicuspid is actually in Brodie bite.) Some
degree of linguoversion in the mandibular posterior
segment is normal, but this seemed in some
degree of excess. Also, the pretreatment lower
incisor position is fairly upright. I was prepared
to possibly extract a lower incisor, depending
on how the first six months went, and made the
patient and parents aware of that.
Progress photos are shown in Figs. 4-7. Early
on, I used light IPR multiple times because
space was being made for the lower left lateral
and lower left canine. Given the position of the
maxillary central incisors within his smile and
face, my aesthetic treatment goals involved
increasing the labiolingual inclination but not
bodily retracting them. Upper incisor brackets
were flipped/inverted to allow an increase in
inclination as alignment proceeded in early
undersized round wires, while also limiting the
end range of that inclination once in slightly
undersized rectangular steel; 0.016-by-0.025inch
stainless steel was strategically chosen
as the final wire to limit this in the flipped/
inverted setup.
JULY/AUGUST 2024 | 14 | ORTHOTOWN.COM
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Orthotown July/August 2024
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