A 64-year-old man has multiple restorations.  The tooth #2 seems to have root resorption.  The tooth #27 has recently finished RCT.  It appears necessary to establish sound occlusion on the left side by placing an implant at #14.  First at all, the mesially tilted tooth #15 needs to be uprighted (Fig.2).  The implant crown at #10 will be used as an anterior anchorage, since the three teeth (#11-13) are usually not strong enough to distalize the 2nd molar.  To prevent debracketing at #10, a diamond bur will be used to roughen the crown surface and new bonding agent is applied.  The second easily debracketing spot is #12 (crown), which could be used bicuspid band.  The 3rd option to reduce debracketing is not to use rectangular wire initially.  When the space at #14 increases to 8 mm mesiodistally, an implant will be placed.  Once the implant is osteointegrated, a band is applied.  From that point on, a rectangular wire could be used.  If debracketing occurs at #10, it does not matter, as the posterior anchorage has taken over.  Save all of wires used initially, since wires may have to return to thinner ones when #14 band is loaded.  To unlock the occlusion (to distalize #15 without interference), composite will be applied to one of FPDs on the right side.  The distal marginal ridge of the tooth #18 (Fig.1 *) may need to be trimmed.

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Xin Wei, DDS, PhD, MS 1st edition 04/09/2018, last revision 03/22/2020