TOWNIE TREATMENT CASE CASE STUDY Fig. 1 Changing a Smile (And a Life) BY DR. BRYAN NAKFOOR S miles Change Lives (SCL) referred this patient to our practice when she was 14. At her initial consultation, full records were taken, including a panoramic X-ray, cephlometric, photos and scan (Fig. 1). The clinical exam presented late mixed dentition; the patient was Class III skeletal, her upper incisors were flared, the lower midline was right 2 mm, the upper left canine was buccally impacted and the right was ectopic. The lower right and left second molars were impacted because of severe crowding. The patient had begun puberty about two years before treatment. The following treatment plans and objectives were recommended based on the clinical exam. Option 1: * Refer to extract the remaining primary teeth. * Rapid palatal expander. * Upper and lower orthodontic bonding. * Refer for exposure of the impacted canines (if needed). NOVEMBER 2023 | 16 | ORTHOTOWN.COM The advantages of this option included avoiding extraction of permanent teeth. The disadvantage of this option was the unpredictability of using the expander, given the patient age of 14. Option 2: * Refer to extract the remaining primary teeth and all first premolars. * Upper and lower orthodontic bonding. * Refer for exposure of the impacted canines (if needed).http://www.ORTHOTOWN.COM