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    Jeremy Bywater

    Hi there, I was hoping to ask your opinion on this case. This patient in her thirties is hoping to improve the alignment of the teeth and after discussion would be happy with keeping the spaces in the lower premolar area and then considering restoring these with direct/reinforced composite after alignment. I have had a setup back from Clear correct and as you can see they have maintained the LHS canine relationship as is be retracting the lower anteriors. My question is would you recommend to avoid retruding the lower incisors this amount, thereby reducing the overjet and possibly improving anterior guidance and perhaps ending up with the LHS canines close to class I. I’m also considering her fairly flat facial profile and wonder if this can be improved, or would want to avoid making this more pronounced.
    set up:

    Freedom Dental

    Hi Jeremy, great questions and interesting case…
    You need to ask yourself, what does the patient want?
    Did she ask for anterior guidance and is she having issues with her mastication function and TMJ motions?
    My suggestion is not to retrude the upper or lower anterior arches and only ensure only rotation and alignment correction as they are and to maintain gaps distally to upper 3’s and lower pm and use composite to close gaps and prevent relapse as see fit?
    This can ensure a quicker time in order to establish the aesthetic solution and provide the patient what she wants.
    However, if the patient wants functional result and or you decide it is a fundamental need, then my suggestion is posterior segmented mesialisation to close gaps in both arches rather than anterior retrusion in order to maintain upper lip position.
    Hope this makes sense? Please ask away?
    To send this back to adjust ask the technician to align teeth as is without retrusion and maintain gaps where you see fit with distal to upper 3’s etc.
    Best regards, Dr John

    Jeremy Bywater

    Yes that makes sense, thank you.


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