Blocked-out Incisors

A 37-year-old man requests orthodontic treatment for severe crowding with 3 blocked-out incisors (Fig.1-5: 12,22,31 (International numbering, pronounced one two, two two and three one)).  The upper and lower arches are pointed (Fig.4,5).  The best option is extraction of 4 bicuspids (Fig.11-15).

His profile is convex with lip strain.  After alignment of the anterior teeth, check the facial profile to determine whether it is necessary to distalize the anterior teeth or not.  If it is, the distalization will be done with the aid of an implant at 47 (Fig.1,5 (residual roots)) and 3 mini-implants at the 3 other quadrants.  An extra mini-implant will be placed at the upper right quadrant to intrude 17 (Fig.1 arrow).

There may be limited space for placement of these blocked out incisors.  Do not have to place them at the time of bracketing until space has been created by arch wire sequence and open coil spring.  It would be ideal to use labial torque brackets or place brackets upside down (Jenny's idea).  In fact, the patient finishes ortho treatment in an orthodontist's office without intrusion of 17.  Magicore will be placed at 47 to intrude 17 or simply for restoration.

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Xin Wei, DDS, PhD, MS 1st edition 04/02/2016, last revision 03/10/2019