“Always remember, no bicuspid should ever be extracted in a quadrant where there is an impacted cuspid until it is absolutely clear the impacted tooth can be retrived! That would be a tough day if you extracted an upper first bicuspid only to learn later that the impacted cuspid in that quadrant happened to be ankylosed.” Fig. 13 Fig. 14 Fig. 12 the most practical, cost effective, and aesthetic treatment alternative. The results of your case could be further enhanced with bone screw anchorage. (Figs. 12-15) Always remember, no bicuspid should ever be extracted in a quad-rant where there is an impacted cuspid until it is absolutely clear the impacted tooth can be retrived! That would be a tough day if you extracted an upper first bicuspid only to learn later that the impacted cuspid in that quadrant happened to be ankylosed. There are cases where more is needed than simply alignment of the teeth. Some patients desire significant changes to their face frontally and in profile. This objective is known as “dento-facial orthopedics.” Extraction of teeth is a power-ful tool to orthopedically shrink an alveo-lus. This is why some Class II cases are best treated with upper extractions while some Class III cases are best treated with lower Fig. 15 extractions. In general, extraction of teeth more anteriorly can facili-tate more profile change. Consider this case where the four cuspids www.orthodontics.com Summer 2019 35
Journal of the American Orthodontic Society Summer 2019: Page 35
