Orthotown March 2018 - 26
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Another Case for UCLA98
Watch this Townie's complex patient case progress over two years
str8nerinva
Member Since: 03/12/08
Post: 1 of 14
This is a case that is on the other end of the spectrum from the case that Charlie brought to
the table in his post "A Case for UCLA98." A 13.8-year-old boy, profile and upright incisors beg
for non-extraction, but that much arch development is not within my comfort zone.
Extracting U+L 5s and reciprocal push between 4-2s would help procline the incisors while
retracting 4s to get room to align 3s. Also, U5s are smaller than U4s.
But on photos, all 3s appear to be right on top of the 2s. Pano doesn't look as unfavorable.
Following the adage of "extracting close to the problem," extracting 4s would be simpler,
more time-efficient, and probably involve less total tooth movement (as per UCLA98) ... but less
opportunity to obtain proclination of the incisors.
Thoughts from other Townies? ■
5/24/2016
Dr-T
Member Since: 05/19/09
Post: 2 of 14
These are always the toughest cases, in my mind, because they are in between extraction and
non-extraction. Although I rarely do it myself, taking out the 5s instead of the 4s might be a good
balance for this patient. I feel non-extraction will be unstable in retention. ■
5/24/2016
orthothai
Member Since: 10/14/13
Post: 3 of 14
Why do you not start non-extraction, then evaluate? That's what I do in borderline cases-at
the end of the leveling, I ask the patient if the profile and smile is OK, or if they wish to bring
it more inside. ■
5/25/2016
Fenrisúlfr
Member Since: 02/25/09
Post: 4 of 14
26
This case also has a transverse issue that needs to be addressed-the maxilla seems very
constricted, as do the mandibular buccal segments.
I would consider RPE on the upper and decompensate the lower buccal segments (working
up to 19x25 SS from the 4-7, stepped around the 3-3). The RPE can also provide some room
for alignment.
MARCH 2018 // orthotown.com
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