Case 3: Removal of a lower incisor Fig. 4a: Primarily upper crowding with much lower irregularity. This situation illustrates one of the first adults I treated where lower incisor crowding was not because of relapse. This patient had always wanted braces, but her restorative dentist suggested she obtain treatment first. There was more crowding in the lower arch, partly from a primary tooth-size discrepancy and many restorations. A trial was performed to see how feasible it was to remove the one lower incisor. After reviewing the casts, it was clear that a lower incisor extraction would not result in excessive overjet. To completely couple the dentition, some IPR of the upper dentition would assist in retracting the maxillary anterior teeth into proper occlusion. One lower incisor was removed and, as you can see, the upper IPR helped with the overjet. The patient finished with each of the lower canines positioned underneath the upper lateral incisors. This provides a functional occlusion with disclusion during lateral motions. Fig. 4b: Lower crowding was more severe than the upper. Figs. 4c and 4d: A trial wax-up shows how little IPR would be required to keep the anterior teeth coupled. Fig. 4e: IPR was performed to achieve coupling of the incisors. Fig. 4g: A bonded lower incisor. 54 SEPTEMBER 2017 // orthotown.com Fig. 4f: The maxillary midline splits the lower remaining incisor.http://www.orthotown.com