Neither of his upper canine or his lower right canine had enough space to fit in their arches. As you can see in the start of treatment photos, his lower right canine was not centered (from inside to outside) in the bone. As a result, the gum and bone tissue on the outside of this tooth is thinner than it should be and this tooth is at risk of periodontal disease (loss of gum and bone support) and loss. Expanding the arch forms was not a good option because the adjacent teeth would need to be moved off the bone to the same extent as the canine, putting them at periodontal risk. The crowding was too severe to create enough space by stripping.

Notice the midline discrepancy in the top left photo. His lower midline started out shifted to his right. Note that they are aligned in the corresponding end of treatment photo.

This patient had four first premolars removed in order to provide enough space to bring in his canines and correct the lower midline discrepancy. Total treatment time was 24 months.

Start of Treatment
End of Treatment

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