Fig. 11 Fig. 12 “Normally, I am averse to unnecessary tooth removal; I prefer expansion to aid in maintaining airway and expanding the buccal corridors for a wider smile. In most cases, when premolars are removed, there is some retraction of the anterior tooth segments as part of space closure. This can deteriorate the overall volume available for the tongue and possibly reduce the amount of airway.” removal; I prefer expansion to aid in maintaining airway and expanding the buccal corridors for a wider smile. In most cases, when premolars are removed, there is some retraction of the anterior tooth segments as part of space closure. This can deteriorate the overall volume available for the tongue and possibly reduce the amount of airway. I discussed a number of treatment options with the mother. Her daughter was also not overly motivated or compliant to spend the time needed for retraction and expansion. In addition, her oral hygiene was good, which was unlike her brother, but her diet had resulted in some caries.This led to some concern about damage to the teeth due to excessive time in orthodontic appli-Fig. 13 ances. Timing was convenient for a serial extraction, which the mother agreed to in order to move forward now that her Phase One treatment was finished and the plan to go into Phase Two orthodontics after her entire permanent dentition was present had arrived. The daughter presented back for routine care as the extractions progressed and no additional orthodontic forces were applied. The patient’s mother brought her in to begin orthodontic care after about 18 months from when the serial extraction was performed. She was presented as in the following pictures. (Figs. 11-13) The bite had deepened to a moderate extent and the teeth had some retroclination on the upper arch. The dentition was in a Class 1 occlusion and very stable. I discussed the options with the mother, who explained her daughter was happy with her smile, and she declined further treatment. Overall, I think the daughter ended up showing a wider buccal corridor. Yet her brother's anterior denti-tion will be less stable without continuous retainer usage due to a Bolton discrepancy. The mother asked me why everyone doesn’t do braces without brackets, wires or cost, and I assured her that there are limits to the treatment. This was consid-ered a more than lucky result. 18 Summer 2018 JAOS
Journal of the American Orthodontic Society Summer 2018/Buyer's Guide: Page 18
