MESSAGE BOARD 2 Maxillary Midline Shift Townies discuss treatment mechanics to help the OP get things moving Colorado108 Post: 1 of 8 4/18/2023 Townies, I would like your input on moving the maxillary four incisors en masse to correct a maxillary midline that is not coincident with the facial midline. I find the most " predictable " way is using a power chain one incisor at a time (centrals as one unit). This does prolong treatment completion. I have tried using a closing loop on the side, which the midline needs to move toward, and an opening loop on the contralateral side. A very accomplished professor during my ortho residency told me that a power strap one tooth at a time will be the most predictable method to center upper midline. His experience was that a closing arch would close space distal to the lateral incisor, but end up with the maxillary midline still off-center once space is closed. Any better and more efficient treatment mechanics or techniques would be welcomed. My clinical finding is that most off-center midlines are off to the patient's right. Tilt of the Earth? Fenrisúlfr Post: 2 of 8 4/18/2023 Do you have pics? I'd PC from the molar on that side that needs moving and back it up with Class II els on that side and Class III on the other side. socoortho Post: 3 of 8 4/18/2023 Fen, I have a question for you. When I extract one premolar to move the maxillary midline, I always fight a maxillary transverse constriction on the extraction side. Besides using a full-size archwire, do you have a suggestion to offset narrowing the anterior buccal area? I've tried to add an " active " TPA but found it cumbersome and not really helpful. Thanks. Fenrisúlfr Post: 4 of 8 4/18/2023 It may have to do with what's happening in the lower arch as well. Some expansion in the lower and narrowing of the upper can create this issue. I very early exo one bi. Either 2, 3 or 4. Some lower IPR should help the fit. Colorado108 Post: 5 of 8 4/18/2023 The type of cases I was referring to with maxillary midline shift are not premolar extraction cases but ones that have developed 2 mm of space distal to the upper left lateral after initial alignment and mild archwire expansion. The midline has shifted to the patient's right or was there before ortho. How do you prefer to make the maxillary dental midline coincident with the facial midline? (Biomechanics.) JUNE 2023 | 20 | ORTHOTOWN.COMhttp://www.ORTHOTOWN.COM