Greetings all. Thank you for at least looking. This is one of the cases that you learn from doing.
I need some help from my fellow tooth geeks.
I'm going to lay out the case, and then come back with a follow up post about the solutions I have.
I have been handed this case by a minor's Orthodontist. What I know about Ortho could fill 1/2 a sheet of paper, and the Doc knows that, but together he and I sat down and came up with one solution, but I want to be certain it is the best possible. He was referred to me by a GP DDS as his Ortho lab was uncomfortable.
The patient congenitally has no max anteriors, nor did the ridge develop. He still has his deciduous premolar and molar on R and L, but they are undererupted and offer no undercuts being cusps only, at around a 45deg angle.
It has been discussed that anything we do will need to be replaced or updated every year or two as he matures, that being one of the challenges in planning. Also, plans are afoot for surgical specialists for a building of the missing structures to provide a permanent adult solution in the future. But that is not possible yet.
The goal is to get this young fellow some anterior teeth, lip support, and possibly fundamentally change his life.
Here's some pictures, I've tried to include as much visual information as possible, but if there's something that didn't show well, please ask.
The provided bite is arranged correctly, but open roughly uniformly. The mand ants are about 1.5-2mm from the max arch at natural closure. Some mild opening is already being done by the additions to the mand premolars that are visible.
View attachment 26395 View attachment 26396 View attachment 26398 The shadow will hopefully offer some depth inference.
View attachment 26397 View attachment 26402 Measurements (the tip of that ruler is cut to about 1mm longer than the 0 point)
View attachment 26399 View attachment 26400 View attachment 26401 View attachment 26407 The position of the lower anteriors is slightly anterior of standard for having no antagonists, and that is being reined in by the braces. My initial guess of the proper labial surface arch is in pencil.
What would you offer/suggest/plan/provide were this your case?
