Case ReportHERBERT PASKOU', D.D.S.Elizabeth, N. I.DIAGNOSISThis malocclusion is classified asClass 11, Divisioii 2 with a missing up-per right central incisor. All remainingteeth are permanent and present withthe exception of third molars. Spaceclosure is obvious with mesial migrationof all teeth anterior of the maxillaryfirst premolars. The left central in-cisor appears directly in the midlineof the face. Occlusion of the posteriorteeth appears edge-to-edge tending to-ward Class I1 interdigitation.HI s TORYThe patient was first seen at ageeights years and six months. She favaredthe right side in masticating and apossible lip-biting habit was present.Questioning revealed the following: afa!! at age three was responsible forthe loss of the maxillary right deciduouscentral incisor; the maxillary rightpermanent central incisor which erupt-ed at seven apparently was defective,and it too was lost due to trauma soonafter. The case originally presented it-self as a Class 11, Division 1 withmutilation as above; however, as theyears ensued, the procumbent anteriorsapparently were linguoverted by normallip pressure. The patient was observedevery six months or so until July, 1955,at which time a complete case analysiswas made.ETIOLOGYThe hereditary aspect of this casemust be considered of etiologic sig-nificance, ordinarily producing a Class11, Division 1 malocclusion. However,the loss of the permanent right maxil-lary central incisor has produced amutilated Class 11, Division 2 maloc-clusion. TREATMENT PLANIn view of this mutilated condition,removal of the maxillary left centralincisor is indicated, followed by align-ment of the roots of the lateral in-cisors while moving them into closerapproximation. Adjustment of buccalinterdigitation into a completely ClassI1 relationship is needed. When align-ment is completed, the maxillarycanines can be shaped to resemblelaterals, and the true laterals jacket-crowned to resemble maxillary centralincisors. The lingual cusps of themaxillary first premolars can be re-duced, to resemble canines.APPLIANCESFn!!nwing the removal nf thp maxil-lary left central incisor, edgewise bandswere placed on the maxillary lateralincisors, canines, first premolars andfirst molars. By gentle pressure of intra-maxillary elastics from the left to rightlateral, these teeth were moved mesially.This was followed by mesial migrationand improved interdigitation of theposterior segments; meanwhile roundarchwires were placed beginning withan .014 and ending with an .021 by.025 with vertical loops and tie-backsincorporated.A retaining appliance of the remov-able Hawley type was to be placed im-mediately following therapy. Jacket-crowns were to be prepared andcemented soon after, and the case'socclusion equilibrated.PROGRESSThe patient was seen from two to60 Vol. 29, No. 1Case Report61Fig, 1 Left, inbraoral photographs taken prior to treatment. Note missing maxillary rightc@ptral fncisor rtsd Olass IT tendency of posteriors. Right, intraoral photographs made one out of retention wlth jacket crowns on laterals to resemble centrals and equilibratedc@sin@ig ra8emblhg lateral incisors. 62 Paskow January, 1959four week intervals following bandplacement. Cooperation in wearing theintramaxillary elastics was good. Hy-giene was excellent. Bands were firstcemented in August, 1955; the edge-wise archwire inserted in January,1956. Bands were removed in Septem-ber, 1956 and the occlusion retained.The retainer was worn while thefamily dentist prepared the jacketcrowns, but was discarded immediatelyfollowing crown cementation. InDecember, 1956, the occlusion wasequilibrated and final records taken.CONCLUSIONSCorrection of facial and intraoralcosmetics is noted, a midline has beenrestored and central incisors have been"replaced". Functional improvement isnoted in the posterior segments by ex-cellent interdigitation, but of a Class I1relationship.Active treatment was of but oneyear duration. An attempt at treatingthis case without any extractions (asa Class 11, Div. 1 or 2 case with headcap or intermaxillary elastics) un-doubtedly would have taken muchlonger and would have required a re-movable and later a fixed restoration.Extraction of maxillary (and mandib-ular) premolars was also considered,but treatment would have been morecomplex. X-rays taken following treat-ment revealed improved root parallel-ism of lateral incisors and little, if any,root resorption.Acknowledgment for the cooperation andtreatment planning as well as the excellentrestorative dentistry must be given Dr. W.W. Jordan of Cranford, N.J.1139 East Jersey StreetThe AngleOr thodon tistA magazine establishedby the co-tyorhersof Edward H. Angle,in his memory . . .Edifor: Arthur B. Lewis.Business Manager: Silas J. Kloeh,:.Associafe Edifors: Allan C. Brodie.Morse R. Newcomb. Harold J. Noyes,Robert H. W. Strang, Wendell L. Wylie..Vol. XXIX. No. 1 January, 1959