1 - The rationale for starting this patient now is the following. There is not enough room for the central, lateral and cuspid to come into the mouth. If we start Orthodontic treatment now, the lateral can move labially into alignment with the central incisors before the cuspid comes down far enough to interfere with the erupting incisor teeth.
2 - We are starting the treatment with a 12 nitinol upper archwire, which is the smallest archwire that we use. The central incisors are being moved together and the upper right lateral is moving distally with a memory chain that has very little force on it.
3 - We want to keep the force on the apex of the roots of the tipping incisors below a root resorption threshold of 1 g/mm². To do this, the force at the crown of the tooth needs to be below 20 g of linear force or we will get root resorption on both the central and lateral incisors.
4 - Now we have engaged the upper right lateral directly to this small 12 nitinol archwire. This small archwire can rotate and align the teeth very quickly without causing root resorption. When the archwire is engaged into the lateral bracket, the tipping force at the crown of the incisor teeth will be low enough to keep the force at the apex below the root resorption threshold and will not cause resorption at the apex of the root.
5 - This is month four of the treatment and we have an 18 nitinol archwire in place in the upper arch. The upper first bicuspid has been moved distally into an extraction space to make room for the upper cuspid to come down into the arch.
Up to this point we should not have any root resorption issues on the upper incisor teeth.
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