Fig. 6 Fig. 8 Fig. 9 Fig. 7 Alignment (Fig. 10) Increase lower arch length with lower utility arch (Fig. 11) Serial Extraction Serial extraction cases are relatively rare but they do exist. From a very early age it can be apparent that the combination of lower crowding, skeletal open bite, Cl II, and protrusion are significant enough that extrac-tions are inevitable. (Fig. 12) The “kind” way to treat many of these cases to opti-mize aesthetics, stability, and periodontal health is to remove some deciduous teeth early (serially extract). Typically, the crowding is so severe that even the parents clearly see that the jaws are too small for the teeth. In fact, early loss of the lower C’s by eruption of the lower permanent laterals might be seen as Nature’s Fig. 10 way of serially extracting the case. Certainly if we see a lower D right next to a lower permanent lateral we should at least consider serial extractions to permit better eruption of the lower cuspids. Poor management can result in unnecessary eruption of a cuspid into mucosa rather than into attached gingiva. Or even worse can result in impaction of lower cuspids. While arch development can align even the most crowded dentition, it is often wise to accept the fact that some patients have jaws too small for the size of www.orthodontics.com Winter 2017 25
Journal of the American Orthodontic Society Winter 2017: Page 25
