Fig. 25 Fig. 22 Fig. 23 Fig. 24 Fig. 26 Case 2 (Figs. 22-28) This is a full orthodontic case starting in the mixed dentition. This patient was in the process of under-going serial extraction by another practitioner. Notice that all four primary cuspids have already been extracted (Figs. 23 and 24). The extraction spaces are completely closed thus leaving no room for permanent cuspid eruption (Fig. 24). Had this patient continued treatment with this original prac-titioner, all four first bicuspids would have been extracted, result-ing in straight teeth but collapsed arches, reduced skeletal vertical dimension and a flattened facial profile. As per Sassouni Plus 2 param-eters, it was determined that the arches could be fully developed Fig. 27 without having to extract first bicuspids. The maxillary arch was widened with a NPE and the incisors were advanced and intruded with UAW therapy. The mandibular arch was developed with lip bumper therapy (Fig. 25). The lip bumper was positioned at level 1 vertically allowing the 12 Summer 2022 JAOS
Journal of the American Orthodontic Society Summer 2022: Page 12
