CBCT is critical. I'm guessing that the canines are palatal, and I might think about exposing them before extracting the peg laterals. On the left side extraction of the peg would leave a big space with two impacted teeth. Interesting case. ■ tom525 Member Since: 06/18/08 Post: 3 of 5 3/6/2018 Thanks for the responses so far. As I pondered this case throughout the day I started thinking about a non-extraction approach to begin with. Perhaps extracting LLE and distalizing LL43 to make an appropriate space for an implant at LL5. I think I could always extract but keeping everything while bringing impacted teeth in seems to make the most sense. I will take a look at CBCT and dive in! ■ straight toothener Member Since: 12/30/04 Post: 4 of 5 3/6/2018 Tough case! I would definitely start non-ex as there is a Class III tendency there. Good luck and keep us up to date. You could be a real hero here, but it's going to take some time. ■ JohnnySS Member Since: 10/18/13 Post: 5 of 5 3/12/2018 Have other ideas for treating this patient? Search: "Missing LL5" To weigh in on this case or simply ask "straight toothener" how it turned out, visit orthotown.com and search the message boards for "missing LL5." This message board will be the top result. orthotown.com \\ JUNE 2018 19http://www.orthotown.com/messageboard/thread.aspx?a=11&s=6&f=693&t=308464&g=1 http://orthotown.com/register http://www.orthotown.com