Table 1 Timeline of patient diagnosis and treatment

1.

Presumed retention of tooth 14 with extraction of deciduous tooth 54 by the referring dentist to facilitate tooth eruption and radiological imaging (OPG)

2.

1 year later: Initial orthodontic screening and referral to physician and endocrinologist

3.

Diagnostic orthodontic records: Clinical examination and model analysis

4.

Beginning of treatment within the maxilla

 •placement of fixed orthodontic appliance and placement of the skeletal anchorage

 •right upper quadrant: extraction of persisting deciduous teeth, surgical exposure, bonding of EWC® appliances and repositioning of mucoperiosteal flap

5.

1 week later: First activation of EWC® springs within right upper quadrant

6.

4 weeks later: extraction of persisting deciduous teeth within the left upper quadrant, surgical exposure, bonding of EWC® appliances and repositioning of mucoperiosteal flap

7.

1 week later: First activation of EWC® springs within left upper quadrant

8.

about 3 months post treatment start within upper jaw: treatment start within the mandible

 •extraction of persisting deciduous teeth and spontaneous eruption of premolars

 •placement of fixed orthodontic appliance

 •right lower quadrant: surgical exposure of tooth 43, bonding of EWC® appliance and repositioning of mucoperiosteal flap

9.

1 week later: First activation of EWC® spring within right lower quadrant

10.

Every 4 weeks after respective first activation (upper/lower jaw): Clipping of the EWC® coil spring (activation) by 2 (1) mm

11.

At tooth eruption: removal of coil spring and further traction by a Powertube™25 attached to lingually, then - when possible - buccally bonded buttons and the circumferential 0.017” × 0.025” SS arch-bow

12.

Superelastic NiTi circumferential arch-bow (final extrusion and levelling) with correction of lower midline deviation by canine uprighting (superimposed power chain over arch-bow from lateral right incisor to left first premolar)

13.

Subsequent TMA circumferential arch-bows (finishing)

14.

Removal of skeletal anchorage