Fig. 24 Fig. 25 “For those of you that are skeptical, here is a challenge: Please find a patient in your practice that has been missing an upper 6 for more than 2 years. You will never observe that Class II remains on that side.” tally missing Upper 2's the treatment decision is often best determined by the molar relationship. If the molars are Class I, you can either: a) Add back the Upper 2's with implants to get the "best" aesthetics b) Leave out the Upper 2's and extract two lower teeth (most typically the lower 4's) If the molars are Class II you can either: a) Add back the Upper 2's and extract 2 upper teeth (typically the U4's OR the U6's) b) Leave the Upper 2's out. This is what we suggest in this case. Do some esthetic recontouring of the Upper 3's to look like laterals before bonding the brackets. Also be sure to use High torque brackets on the upper incisors to prevent de-Fig. 26 Fig. 27 torquing of the crowns during anterior space closure. Finally use cuspid brackets on the upper 4’s that will now be substituting as cuspids. (Fig. 28-30) 4.f) Extraction of Upper 3’s. If a patient has Class II and also has impacted cuspids, the case can be greatly simplified without compromise if the upper www.orthodontics.com Summer 2020 31
Journal of the American Orthodontic Society Summer 2020: Page 31
