Orthotown December 2017 - 21

message board

9/24/2017

Shwan
Member Since: 08/02/10
Post: 4 of 7

Thank you for your replies and for showing the case, Fenrisúlfr. But your case is extraction case.
My question regarding my case is: Could I intrude the lower incisors and upright them without
extraction? Intrusion needs space and correcting the inclination of these proclined incisors also
needs space. Do you think IPR will be enough? I'm afraid that I'll be left with residual spaces in
upper that I will not be able to close. ■
9/24/2017

davidharnick
Member Since: 08/28/02
Post: 5 of 7

Thanks for posting this case. Tough combination. Nowadays I do a free 3D simulation
prior to starting regardless of the appliance. My approach would be to start non-extraction and
then reevaluate. I would probably not be so concerned about up righting the lower incisors, just
clearance to retract the upper incisors. This profile does not call for extractions so my best guess
is lower IPR PRN. I am not used to not having more precise measurements prior to starting. ■
9/24/2017

Shwan
Member Since: 08/02/10
Post: 6 of 7

Thank you for your reply. I agree about the value of 3D simulation, unfortunately, I don't
have that luxury yet. Also, I agree 100 percent about the profile, she has a big nose and prominent
chin, extraction will not be good for her face.
My point about up righting the lower incisors was actually mentioned as a mean to provide the
required clearance for upper retraction, she has class I molars, if I leave the lower incisors proclined
like now, I don't think I'll be able to get ideal overjet and overbite and close all the upper spaces. ■
9/24/2017

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

22

That was not an extraction case in the traditional sense...it was a case Tx with extractions
and Class II camouflage 20 years ago and now retreated with decomp and two jaw surgeries.
Thus, the challenges were like the ones you face with no space in the lower arch, a deep bite with
a significant step anteriorly and some mand. arch crowding. Below are the pre-surgical images...

DECEMBER 2017 // orthotown.com


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