Orthotown September 2017 - 20

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fesdds
Member Since: 05/22/08
Post: 6 of 14

Fenrisúlfr
Member Since: 02/25/09
Post: 7 of 14

charlestonbraces
Member Since: 06/05/09
Post: 8 of 14

Ditto Fen. Don't like L4s due to overretracting or upright lower incisors, and if any space opening
in extraction site it is more distal with L5s. But those molars are too much Class III for me. ■

5/29/2017

Yep ... with lower 4s, it can be challenging to prevent overretraction. ■

5/29/2017

I have to think about this more, but looking at the midlines, they are not that bad. So, this
was a case where the LL6 simply moved forward with minimal ML shift from the anterior. Let
us assume for a moment that the LL5 was completely blocked out (instead of ¾ blocked out).
If you extracted the LL5 and either the UL4 or UL5 (as part of a four-premolar extraction
plan), your canine relationship would change from the strong Class I it is now to Class III, unless
you fully protract the entire UL quadrant. I don't know about you, but I am not in the habit of
taking out a premolar just to try to drag the molars into its place. I have to think about this more,
but I think I will come up with some asymmetric plan. Maybe just the LL5, maybe the LL5 and
the right 5s (leaving the UL5). I don't know. But I think this is not symmetrical. ■

5/29/2017

crk
Member Since: 09/10/11
Post: 9 of 14

ucla98
Member Since: 09/28/07
Post: 10 of 14

I would extract L4s/ U5s. ■

5/30/2017

I'd extract the LL5 and use Class II elastic to further mesialize the LL6 to full-step Class III and
use Class III elastic to correct the weak Class III on the right side. This patient probably lost the
LLe prematurely and the LL6 drifted forward. At the end of treatment, the lower ML may be off
to the left by 1-2mm, which IMO, is not a big deal-just like most lower incisor extraction cases.
I like the existing position and inclination of the upper incisors so I wouldn't want to
disturb this for long-term stability. The lower incisors are slightly upright (some existing dental
compensations for a skeletal Class III). Therefore, I wouldn't want to remove a lot of teeth in the
lower arch to further upright these lower incisors. ■

5/30/2017

Gotitstr8
Member Since: 04/01/09
Post: 11 of 14

Consider extracting the LL6, then using reciprocal anchorage to position the LL7 into Class I.
The right side could be managed with IPR and elastics. If desired, the LR6 could be distalized
after extracting the carious LR7, then uprighting LR8 when erupted. Good to avoid extractions
on this upper arch with patient's Class III tendency. ■
5/30/2017

emac
Member Since: 11/21/11
Post: 12 of 14

I would extract the LL5. Hopefully the dentist can get it out. If he complains a lot then you
could extract the LL7, or try to open some space for the 5. I wouldn't extract the LL4, because
that would make the treatment harder. It looks like the patient is going to need a filling in the
LR7; that may be easier to do after uprighting. I would also suggest extracting all 8s except LL
posttreatment. Just my Monday morning QB. ■
6/26/2017

drleonk
Member Since: 08/24/13
Post: 13 of 14

Lower 5's. ■

Which Townie's advice is tops? Weigh in online
Search: "Extraction or Non"
Does the proclination in this case make it extraction-worthy? To share
your opinion on the Orthotown message boards, head to orthotown.com
and search "extraction or non"-this message board will be the top result.

SEPTEMBER 2017 // orthotown.com

6/26/2017

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