Figure 5

Age 11.4. Day 0 in braces. Situation after surgical exposure of 15, 24, and 45, and extraction of 13, (supernumerary) 23, 33, and 43. Syndrome-related extraction decisions, different from that in "traditional" extraction cases, were made: because tooth movement could not be predicted, it could have happened that after extraction of premolars (which had already proceeded further to the occlusal plane; compare Fig. 3), the canines, which have a lower eruption grade, could not have been moved orthodontically to the occlusal plane (compare Fig. 3). Finally, this would have resulted in lack of two teeth (canine and first premolar) in each quadrant. Therefore, because of the risk of immobility the canines were extracted instead of the first premolars, despite their guiding function and long roots, i.e. despite their high orthodontic, periodontal and prosthetic value. Transposition of 22 and 23 was accepted to remain untreated. Due to tooth position or eruption grade, placement of bands, and brackets 15, 35, and 45, was difficult. Enormous vertical distances between the upper brackets required that the archwire was not ligated to all attachments initially.