Balance & Equilibrium: Orthodontic Treatment with Tooth Mass Balance and Skeletal Anchorage Assisted Protraction to Create Balance

In our practice of orthodontics, we pursue the goals of balance and equilibrium in the esthetics and function of our patients. Some patients bring extremely difficult situations to treat due to multiple variables or complexities involved with their particular conditions. This report will describe the authors’ approach to, a 13 year old female patient (ET) who presented with multiple complex situations. She presented with congenital absence of both second mandibular premolars (#20, #29), crossbite of the second maxillary premolars (#4, #13) and maxillary right canine (#11), multiple gapped areas were present in the mandible and severe crowding occurred in the maxillary bicuspid areas. Her profile was acceptable, and maxillary and mandibular incisors were in good inter-arch relationship and position. The molars were in a Class I dental occlusion, but not the canines. The dilemma was to improve the posterior areas without compromising the existing soft tissue profile or anterior incisor tooth positions.