Orthotown March 2018 - 28

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I don't have any issue with moving teeth a great distance (i.e., moving a canine into a lateral
incisor's position). My main concern is the alteration of the existing arch's perimeter. I don't
like too much arch expansion (i.e., using RPE expansion on nongrowing patient) or too much
arch shrinkage (extractions and overretraction of incisors). If the patient's existing arch form
is naturally narrow, I'd leave it the same instead of trying to widen it. If the patient's existing
incisors are upright (because that's how the oral musculature influence their positions), I'd leave
them the same instead of trying to flare them out to give them ideal posttreatment ceph values.
Extractions of 4s on this kid will leave the incisors and the arch's perimeter the same. The
profile stays the same. It's pretty much a 1-to-1 space exchange.
Extractions of 5s will give this patient slightly more expanded arches (from slight flaring of
the incisors). This is fine with me also and I am leaning toward this tx option. As long as the
change is not too far from the existing position, I am OK.
So again, I think this case can be treated nicely with extractions of 4s or 5s. ■
5/25/2016

str8nerinva

UCLA 98, I like the thought process. Thanks. ■

Member Since: 03/12/08
Post: 6 of 14

Zxzxzx
Member Since: 02/28/03
Post: 7 and 8 of 14

5/25/2016

"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."
After teaching at Harvard for 12 years, I moved over to my alma mater, Tufts, where I've been
for 8 years. About as soon as I come over to Tufts, I asked a resident why he decided to extract
4s in a certain case. His response was "teeth closest to the problem."
I explained to him that that was the old days. Now we look at where the teeth belong in the
face and decide how to get them there. This determines which teeth are extracted.
Notice the mentalis habit and the two planes of occlusion on the buccal view.
Any planes to treat the vertical problem? Or how will it be handled? ■

5/25/2016

Str8edge

"I explained to him that that was the old days. Now we look at where the
teeth belong in the face and decide how to get them there. This determines
which teeth are extracted."
+1.
For me, this is a 2nd bi ext case. ■

Member Since: 07/17/11
Post: 9 of 14

5/25/2016

Fenrisúlfr
Member Since: 02/25/09
Post: 10, 11 and 12 of 14

28

On the lower arch, the 2nd molars and the incisors are at about the same vertical level with
everything else inferiorly positioned.
The COS in her case will be leveled by bringing the buccal segments into occlusion.
Given the existing arch configuration, just working through the archwires will erupt the
buccal segments.

MARCH 2018 // orthotown.com


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