Severe Crowding with Nice Facial Profile

A 10-year-8-month-old woman presents to clinic with severe crowding (especially at the canines, Fig.1), but her facial profile is within normal limit (Fig.2,3) in spite of the fact that cephalometric tracing shows bimaxillary protrusion (Fig.4).  Will 4 bicuspids' extraction affect her profile?  Her mom requests immediate treatment, although the patient's oral hygiene is questionable.

Dear Dr. Shaughnessy: Can you review the following case?  Is it too early to initiate the case as the mom wants?  Should we extraction L Es first and 4 bi next?  Or together now?  After 1st bi ext, distalization of only 3s should not affect the facial profile?  Thanks.

If the crowding is as severe as it appears, I would have no problem extracting the 1st premolars and Es prn. U will not change the profile much at all if any if severe crowding because you will have only small space to close. Do remember from the start that I will need Class I molars so do what it takes to end up there! If you fall short, you finish with xs overjet.
Tim☘️

Return to Ortho Cases

Xin Wei, DDS, PhD, MS 1st edition 07/18/2018, last revision 07/29/2018