Asymmetric extractions in a patient with a hopeless maxillary central incisor, followed by treatment with mini-implant anchorage.

Premolar extraction is 1 option for treatment of patients with malocclusion and severe crowding or protrusion. When the patient has missing or hopeless teeth other than premolars, it is possible to consider removal of those teeth to use the space to decrease crowding. A 15-year-old girl sought treatment for severe crowding. She had already lost her maxillary right first premolar as a result of caries 1 year previously and had a hopeless maxillary right central incisor. Her mandibular left first molar still caused discomfort even after endodontic treatment. Extractions of the maxillary right central incisor and mandibular right first premolar and left first molar were chosen to resolve the occlusion problems. Orthodontic mini-implants were placed to translocate the maxillary left central incisor across the midpalatal suture to use the space in the maxillary right quadrant to relieve the crowding. Although a different extraction option was used in each quadrant, the final occlusion was acceptable. After debonding, porcelain crowns were placed on the anterior teeth to improve esthetics. The treatment result remained stable after 2 years of retention.