A modified serial extraction method in a patient with crowding and a congenitally missing mandibular left second premolar

Background: In pediatric orthodontic treatment, determining the optimal treatment strategy is often challenging. Decisions such as whether to extract teeth and when to initiate orthodontic treatment have been debated for many years. Furthermore, when congenitally missing teeth are present asymmetrically, the selection of a treatment strategy becomes even more complex. Case: A 6-year-11-month-old girl presented with a chief complaint of crowding in the mandibular anterior region. Facial profile examination showed mild protrusion of both the upper and lower lips and a retrusive mandible. The mandibular left first molar was impacted against the mandibular second primary molar, resulting in disturbed eruption and posterior discrepancy. The mandibular midline was deviated 2.5 mm to the left relative to the facial midline. The mandibular incisor axes were inclined toward the left, and space deficiency was noted. Crowding was present in the mandibular anterior region, suggesting a future risk of space deficiency in the mandibular arch. Panoramic radiography revealed that the mandibular left second premolar was congenitally missing. Based on these findings, the patient was diagnosed with a skeletal Class II malocclusion associated with a congenitally missing mandibular left second premolar, mandibular posterior discrepancy, and midline deviation. Conclusions: Early intervention allowed for the implementation of an early extraction protocol in this case. A treatment strategy using Bionator therapy enabled effective control of overbite while simultaneously promoting favorable mandibular growth and improving arch length discrepancy, thereby compensating for the limitations of serial extraction alone and resulting in an efficient treatment outcome. In addition, treatment was completed without the need for a second treatment phase using a multibracket system. Completing treatment during the growth period suggests that this approach may be applicable to similar cases involving congenitally missing teeth.

Early extraction; Functional orthodontic appliance; Congenitally missing teeth

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