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Case details



Before / After

A before and after image

Josipa-Juret-before-orthodontics Josipa-Juret-after-orthodontics-1

Case description

Strong general crowding and impacted canines.

In this case study we have an example of strong general crowding in the upper and lower dental arch and a lack of space for the impacted “blocked” upper and lower canines to “sprout” to their correct position. The total size of teeth was much greater than the size of the jaw where the teeth needed to be set.


The space to align teeth with an orthodontic appliance, any appliance, can be achieved by one of three ways. By expanding the dental arches, by minimally narrowing the teeth via air rotor stripping method and teeth extraction. Even though the expanding of dental arches sounds like the best option and it’s the easiest to do, there are consequences to moving the teeth outwards too much. A long-term consequence is the withdrawal of bone and gums on the teeth which were moved which, from a medical standpoint, puts them in a worse position than they were at the start of orthodontic treatment.

This criteria is biological and the same for any type of orthodontic appliance, whether they be transparent appliances, self-regulating or conventional brackets. Unfortunately, it is in fashion that with every new or “recycled” appliance this criteria is trying to be ignored. The consequences of not respecting this criteria is most often seen months or even years after orthodontic treatment.

By completing an exhaustive analysis (model analysis, orthopantomogram, LL craniogram) it was calculated that enough space for setting the teeth into the dental arch and keeping them there would not be obtained by expanding dental arches and by air rotor stripping . This was important for long-term dental health.


We approached the issue by removing the four first premolars. By doing that we ensured enough space for the “sprouting” of the impacted canines and so that we can then, like other teeth, set them into the ideal position via fixed orthodontic appliance.


In the photos showing the end of orthodontic treatment by fixed orthodontic appliance you can see that the teeth were set into ideal occlusion and healthy gums, seeing as we didn’t stretch the teeth to gain space.

On the profile before and after photos it is obvious that the face profile and lip esthetics were not disrupted in the slightest by removing the four teeth due to correct diagnostics and the use of biomechanics.

All six Andrew’s normal occlusion keys have been fulfilled, which is something we always insist upon. The basis of which for long-term stability, health and chewing function are: the alignment of the middles of the upper and lower dental arch, upper canines being set behind the lower ones in class I relationship, the upper incisors leaning against the lower ones and pass them vertically by an ideal height of 2-3 millimeters, absence of tooth rotations and closing of all gaps between teeth.