Bilateral canine-1st premolar (3-4 trans) transposition! Fixing a single transposition can add up to another year of treatment time to an already lengthy treatment plan. This case of hypercrowding on a well 12 yof will be managed without fixing the transposition, unfortunately. The uptimate goal of this treatment will be to move the teeth back into the arch, achieve class 1 molar and class 1 “canine” (actually going to be premolar) Given the compromise of canine guidance later, the risks outweigh benefits. Risks include: external/internal root resorption, destruction of peridontium of associated teeth (canines will need to be kept “high” approaching the vestibule), loss of buccal and/or palatal cortical bone. Its too much movement with limited medullary bone to move things around in an already constricted maxillary arch (bonded RPE planned later) This tx plan is far from ideal, but if it were my mouth, I’d want it done this way. I wouldn’t want to risk losing 4 upper teeth needlessly. .
New lateral ceph to be taken once teeth are back in the arch and aligned to assess ANB, WITS, FMA, interincisal angle etc etc, yada yada.
Restorative considerations include possibly converting the transposed teeth (canine becomes premolar, premolar becomes canine) via crowns. .
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