Fig. 1 Treatment plan and appliance selection were affected by the following: * The flat upper lip and narrow smile were detrimental in making the decision to treat non-extraction. Our treatment methods should overcome the dogmatic assumption that severe mandibular crowding dictates four-bicuspid extraction by developing the arches. * The position of the canines also dictates that arch development should be done cautiously to avoid any buccal forces that may increase the gingival recession (which would occur if braces were placed first). Arch development should include buccal expansion combined with some distalization. * The patient's poor oral hygiene also affects the treatment methodology: * Oral hygiene often gets worse when braces and wires are in place. This might be a situation where our treatment becomes a race against time, trying to achieve good treatment results before poor oral hygiene forces us to terminate treatment. One option to decrease oral hygiene challenges is to start with smart appliances that develop the arches, thus minimizing the time braces are used. * Poor oral hygiene is often an indicator of future poor compliance. For that reason, using noncompliance methods to develop the arches would improve the predictability of achieving good results. We selected the DMAX-2000 appliance for the maxillary arch and the MSX-2000 appliance for the mandibular arch. Both appliances, developed by Dr. Michael Williams more than 20 years ago, are made exclusively by DynaFlex and incorporate nickel titanium springs that expand the arch and distalize the molars. This combination has JULY/AUGUST 2024 | 25 | ORTHOTOWN.COMhttp://www.ORTHOTOWN.COM