Midline Discrepancy? What are my options? Do more IPR?

Question

Hello, I had removed upper/right 2nd premolar for braces. After 18 months my teeth are straight but my midline is shifted to the right, about 3 or 4 mm (to the mid of my face). My ortho said ther was no space to moved it to the left. She did some IPR but I don't think it is enough. What are my options? Do more IPR? How much space can I get that way (do you think 3 mm is possible?). Elastics or TADs? I don't want to extract tooth! P.S. my lower midline is ok with face.

Brad Lockhart, DDS · Answer

Correcting an overjet by retracting upper incisors is RARELY the best way to correct an overjet and EXTREMELY rare to accomplish by extracting a single bicuspid. 

	It is not possible to gain 3 mm of space from IPR (interproximal reductioin) without severely compromising the integrity of the teeth having IPR. Also, this procedure would require further retraction of upper anterior teeth that are most likely already over-retracted.

	Because of the limited information provided, it's impossible to give specific recommendations about how to fix your specific case. 

	Good luck!

Robert Waxler, DMD, MS · Answer

There are times when extracting upper premolars only can be used for overjet correction. Extracting only one premolar can be done with two big IFs: 1. the overbite is only on one side and two, the lower midline is on. If both of these conditions are met then theoretically the upper and lower midlines will match at the end. If your upper midline is off to the extraction side and the lower midline is on then it sounds like you still have an uncorrected overjet on the nonextraction side...fix this and everything should be fine

Midline Discrepancy? What are my options? Do more IPR?

Answers (2)