This complex malocclusion, defined by a significant discrepancy between tooth size and arch length, not only compromises functional occlusion and periodontal health but also affects facial harmony and overall aesthetics.
Conventional treatment often involves bilateral extraction of premolars to create space and align the dentition symmetrically.
However, when teeth present severe displacement, unfavorable root positioning, or periodontal compromise, asymmetric extraction protocols may offer more efficient and individualized solutions for achieving functional and esthetic balance.
The recent case report published in BMC Oral Health documents the successful management of a 31-year-old female patient with severe dental crowding and midline deviation, treated through a multidisciplinary approach combining asymmetric extraction, fixed orthodontic appliances, and temporary anchorage devices (TADs).
► DENTAL BOOK: Cleft and Craniofacial Orthodontics - 1st Edition - Pradip R Shetye and Travis L Gibson (2023)
This strategy highlights the biomechanical advantages of integrating skeletal anchorage to achieve controlled tooth movement, minimize unwanted side effects, and correct midline discrepancies without compromising facial symmetry.
The treatment plan involved extraction of three first premolars and one severely malposed mandibular canine, selected based on clinical and periodontal considerations as well as space requirements.
The use of micro-implant anchorage ensured precise force control, allowing efficient space closure and optimal midline correction.
After 21 months of active treatment and retention, the patient exhibited stable occlusion, proper midline alignment, and an enhanced smile profile, confirming the long-term success of this individualized protocol.
► DENTAL BOOK: Orthodontics - Diagnosis and Management of Malocclusion and Dentofacial Deformities - Om Prakash Kharbanda
This clinical case provides strong evidence that asymmetric extraction combined with TAD-supported biomechanics can be a valuable option for adult patients with severe crowding and complex asymmetries.
It underscores the importance of personalized treatment planning in achieving both aesthetic and functional stability, offering orthodontists a scientifically grounded alternative for similar challenging scenarios.
For detailed insights into the diagnostic process, treatment stages, anchorage mechanics, and post-retention evaluation, you can access and download the full open-access paper here.
📄 Read the complete article in PDF:
👉 Treatment of an adult patient with severe dental crowding by applying asymmetric extraction, fixed appliance, and micro-implant anchorage: a case report
