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Abstract

A 23 year-old male came with chief complaint of lower anterior crowding and protrusive lower lip. Dental examination revealed missing teeth 14, 24 and 34 and horizontally impacted 38 and 48. Poor prognosis of tooth 36 was found after evaluation. Anterior cross bite and open bite at his left side occlusion were also seen. In this case, removal of teeth 36 and 38 were selected instead of 44 extraction. Thus the timing and proper sequence of tooth extraction become critical. The biomechanics of tooth movement was designed to ensure that all teeth are in functional occlusion and the lower left second molar have long-lasting healthy periodontal condition after treatment. With the assist of temporary anchorage devices (TADs), all the patient’s lower teeth were moved within lower dental arch toward the extraction space of 36. This treatment procedure was addressed in two aspects: 1) protraction of 37 can be in a shorter span to avoid tooth tipping and the treatment duration can be reduced; 2) prevention of periodontal complications at the distal aspect of 37. It is concluded that implementing the periodontal consideration into orthodontics has contributed to a successful and beneficial treatment outcome. The treatment goals were achieved; the treatment results were stable in four-year follow up.

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