Management of an adult patient with missing one mandibular incisor, severe overjet, and midline discrepancy with asymmetric extraction, lingual appliance, and skeletal anchorage: A case report

Abstract

This case report describes the lingual orthodontic treatment of an adult patient with Angle Class I malocclusion, agenesis of mandibular right central incisor, severe overjet and deep overbite, excessive proclination of maxillary and mandibular incisors, and midline discrepancy. Because of unique presentation, symmetric extraction could not be performed in the lower arch of this 34-year-old patient. She was treated with three premolar extractions and absolute anchorage with temporary anchorage devices for maximum retraction of upper anterior teeth. To correct the midline deviation and Bolton tooth-size discrepancy, the mandibular right lateral incisor, canine, and premolars were reshaped to reduce the mesiodistal width. The treatment approach greatly improved the patient's facial and dental appearance and provided a stable occlusion.

Keywords: Asymmetric extraction; Bimaxillary protrusion; Invisible orthodontics; Lingual appliance; Tooth agenesis.