Immediate implant in the palatal socket of upper 2nd molar, Duluth GA Dentist Dental Education Lecture

What would you like to know? I can only give you a gut impression, as there is inadequate records for me to do a full diagnosis. I need the ceph X-ray and tracing numbers, panorex, and occlusal photos.

At a glance, she looks too protrusive, with class II occlusion. If you treatment goal is just alignment (6 month ortho-style, which I inadequate in my opinion), then she will be even more protrusive with a non-extraction treatment plan. I doubt she likes here profile now (what is her chief complaint?).

So, assuming she also thinks her smile is too full, the right plan would be bicuspid extraction for the crowding and class II correction. Extraction to prevent the incisors moving forward during alignment, then use the remaining space for retraction of the incisors as much as possible.

You mentioned she is not concerned with the missing upper molars. An interesting twist on an extraction plan could be this: extract lower 4s only (21,28), On the upper arch, use the 2nd molar space for retraction, by using zygoma place TADs or bone plate with a ligature wire from the anchorage to the anterior archwire, with a niti closing coil spring tied on the ligature. Then you will retract the entire upper arch to meet the lower arch. The will do two things: make the upper arch look non-extraction with two pairs of bicuspids in the full smile, and by distalizing the upper arch, the first molar will be in contact with the lower second molars, preventing relapse of the disrupted arch. The canines will be a class I relation, and the molars a class III relation, which is fine.

Something to think about. The only thing that would be if she is a skeletal open bite now (need the ceph numbers!). If so, then distalization is contraindicated, and the upper #5,12 should be taken, in a conventional manner.

Thanks millions. You do sound like doing thousands of ortho cases. You could find panorex and SNA/SNB # in proper links. I am tracing ceph now. I wonder which system of tracing you have used. I did not attach intraoral photos, which were not taken well.

Basically, my tentative plan is quite similar to yours. May I place two TADs in 2nd molar areas instead of zygoma? Two mini can retract a whole arch? My plan is retract 6s, then 5s, 4s, 3s and 1/2s step by step after arch sequence. power chains both buccal and lingual to prevent rotation. In fact I have already finished model surgery, which will be posted soon.

You don't need lingual attachement if you pull the entire arch. Segmental retraction is fine, but very slow, and unnecessary with skeletal anchorage. Pushing off teeth, yes you would do that. Use Niti coils, not elastic chain that will degrade in two weeks. Niti could give you the exact force you need if you know how many mm's to activate it. A whole arch can be retracted with 200gm per side. It will take a year, but it will work. None of this will work if she is skeletal open bite.

Thanks for info. If you do not give me up, I may reach advanced stage. I love to learn while doing. All of your messages will be saved. If upper arch retraction cannot be done successfully, #5,12 will be extracted. When the patient's finance improves, 2 implants will be placed. Xin

Sorry, I saw the X-ray on the second page. #1,2, 15,16 need to go, also 17 if you can get her to do that. But this case needs a ceph and tracing to determine the right plan. I like my distalization plan still, until proven otherwise. February 23, 2015 11:22 AM

Good. Pan was taken 3 years ago. 1,2,15,16 have been extracted. In order to reduce upper distalization, lower 5,6,7s need to mesialized. Anterior segment could not use up 2 bi space, according to model surgery. #32 extraction does not sound so necessary, even though I would love to do so 10 years ago. I will show you model surgery soon to prove the point. SRP is planned with 17,21,28 ext. I love dentistry because I feel that I am always lagging behind and need somebody to push me up. Thanks

Xin Feb 24, 2015, at 6:28 AM

You don't want the lower extraction space used up by the crowding alone. To me it looks like I would retract the lower incisor 2-3mm also. The molars will come mesial to do the rest.

Model set up is a luxury and not a substitute for proper records. If you had a ceph traced out you would see the lower incisor position and determine is it is good or needs retraction. Then you can decide on your mechanics. A technician setting up teeth on a model doesn't know what can be done in the mouth, nor can they know what you want to do. How can you plan treatment from a model waxup done by an technician?

I got a year oral surgery training at Emory under Dr. Bays. I do model surgery myself, which is quite informative. I did not bring home ceph tracing manual this evening. I will do it in 1-2 days.

As soon as the lower anterior alignment is achieved, I want to mesialize the lower posterior teeth so that upper arch posteriorization will be less. The latter is quite difficult (time consuming) for young kids with TAD, not mention adults. According to model surgery, retracting the lower incisors will make the anterior arch too flat. I do tracing most of cases, but I do not understand significance of each # too much, as related to decision making. Thanks. I cannot wait to read your 2nd message.

You distalize to your target, based on the plan. I don't know how much or if I want tooce the lower incisor back until I see the ceph. Her face says yes I do. Model surgery won't help with that since you cannot control the angle so much. Like waxing up a denture. Just because the crown is upright doesn't mean the tooth is over the center of the alveolus for stability.