Ortho Instead of Implant I

A 40-year-old man requests orthodontics after #17 and 32 extraction.  UL5 is missing (Fig.1), while the upper midline deviates to the left (Fig.2 arrow) with crowding between UL2 and 3 (Fig.3).  The main goal is to retract UL5 distal and move the upper midline to the right to alleviate UL anterior crowding.  Implant will be not needed.  To monitor potential root resorption associated with tooth movement, preop PAs are taken (Fig.4-7).  The space for an implant at UR5 is narrow.  UR4 needs to be distalized using UR7 or a miniimplant distal to UR7 as an anchor (Fig.8).  UR4 and 3 will be repositioned to establish Class I occlusion (Fig.9).  The space gained by UR4 distalization may be enough to correct the upper midline deviation and UL3 malposition (Fig.10).  Brackets will be placed in the lower arch in spite of the normal alignment (Fig.11).  UL2 and 3 brackets are unable to be engaged to 14 niti wire (Fig.12).  Next visit try to engage UL2 bracket.  If not, save the old wire for possible future reuse.

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Xin Wei, DDS, PhD, MS 1st edition 02/13/2020, last revision 02/26/2020