Advice for crowding case

Thats great... nothing more to add...

Great, thanks Ian, that is helpful.

I will follow your advice.

I was thinking it would end up being a better result with fixed so was planning on recommending this option. In terms of pimping up my bracket positioning at bond up I was thinking:

1) bonding 7s to fully express arch form + additional anchorage

2)LR1 and LL1 brackets rotated to encourage root tip towards LL2 extraction site

3)swap LL3 and LR3 brackets or position these brackets to avoid fully expressing root tip on these teeth. My thoughts were that complete resolution of these root positions is unlikely to be practical and trying to is likely to cause weird side effects with incisor dumping or occlusal plane issues??

What do you think? Anything you would add/change?

Thanks

Stephen

Hi Stephen

good to hear rom you.

yeah... interesting case... those distally tipped canines, especially LR3 willl be a nightmare...

The upper premolars... just tip out and reduce the buccal corridor

The anteriors - I do think there is a Bolton discrepancy so taking the LL2 could be a sensible option.... however we need to manage expectations.... so a clincheck to show her that the LL3 will still be retroclined although aligined is a good idea... we wont get any torque with aligners, so show her what it will look like...

Bit of whitening of the canines also..and reduce canine points/add a little composite and your there


Hope that helps

ian

Hi Ian,

Long time no speak!

I would appreciate your advice for a potential ortho case.

Records can be found here: https://drive.google.com/drive/folders/1L4uAaGbujWkFBui8VZhu6lejnMg6PML2?usp=sharing

Pt does not like how her canines stick out more than her other teeth. Ideally would want invisialign!

The patient is class 1 skeletal pattern with low FMPA and reduced mid/low facial proportion. The lips are competent but with maybe slightly flat/concave profile with a normal nasiolabial angle.

The incisors are a class 1 but quite upright with an OJ 2-3 mm and average OB. The mid lines are pretty close.

There is moderate crowding on the upper labial segment and moderate-severe crowding on lower labial and buccal segments.

Molars on the LHS are class 1 and the RHS are half unit class 2. The canines on the LHS are class 1 and RHS are half unit class 2. LL3 in particular has a lot of root tip.

Soft tissues appear slightly thin with high scalloped papillae and some mild preexisting gum recessions.

I was initally thinking four first premolar extractions and then fixed-fixed but I was a bit concerned about her profile and buccal corridoors - If anything I feel she could do with more lip support, not less.
An alternative I considered was extraction of the LL2 and rounding out upper and lower with IPR as required with fixed-fixed or Invisalign. Only concern is gum recessions?

Any advice you could give would be much appreciated.

Many thanks,

Stephen