Case 7.6 (1-12) A 53-year-old woman with a nightmare of losing her upper front teeth came for a visit: the patient was not regularly followed by a dentist. Loss of posterior teeth and support with reduced lower face height. Insufficient lip closure due to lower lip catch. Due to reduced periodontal support, traumatic bite, lip catch and tongue trast, the upper front teeth were mobile and spread out of the mouth with presence of diastema and missing papilla. Increased overjet and overbite with overeruption of upper and lower incisors. Class II molar and canine relationships in both right and left sides. Increased lower C. of Spee and ’V’-shaped upper arch. (15-21) In treatment: (15) visual treatment objectives with three-dimensional representation of the orthodontic correction. Selective intrusion of 21, 22 with a three-piece Burston intrusion mechanics with differentiated activation in order to retract and close mesial diastema. The anchorage was an iron cross with lateral bite (16, 17). After alignment of upper incisors the br were debonded and for aesthetic reasons a palatal retraction system with power arms, Sentalloy coils and power chains was chosen. A special TPA with a double arch was utilized to increase the possibility of application of points of force and to maintain the coils close to the palate. (13,14) The final radiographs were taken in the finishing phase. (22-29) End of treatment: improved soft tissue function and smile aesthetics. A small diastema of 1 mm was left distal to 22 to compensate for anterior ratio discrepancies. All other spaces were closed, achieving a correction of overjet and overbite, distal molar relationship, and neutral canine relationship on the right and left side. (30-37) After prosthetic rehabilitation with metal and porcelain crowns on 16, implant in region 45, 46, and cosmetic reconstruction of upper front teeth. A fixed bonded retainer from 13 to 23 and from 34 to 44 and a night removable upper plate were chosen as retention devices.

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