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Main Instructor Meng-Chang Wu
Cheng-Tsung Huang
Ber-Duen Fang
Wei-Cheng Lee
Department / Institution Division of Orthodontics and Dentofacial Orthopedics, Department of
Dentistry, Tri-Service General Hospital, Taipei, Taiwan
Classification Case report
The objective of this case report was to present the treatment progress of an adult female who had been diagnosed as skeletal Class I malocclusion and Angle Class I with space deficiency, and treated with extraction of maxillary 1st bicuspid and mandibular 2nd bicuspid using fixed lingual appliance. The chief complain of this patient, a 28-year-old female, was teeth crowding and protrusive lips. According to a series of clinical examination, including radiographic analysis, intra- and extra-oral photography and profile evaluation, the patient presented with lip incompetence, mentalis strain and mild facial asymmetry. Crowding of upper and lower arches with square arch form and lateral functional shift were presented. To improve lip incompetence, imbalance lips posture and severe crowding, extraction of four 1st bicuspid was indicated. However, in the panoramic examination, root resorption of mandibular 2nd bicuspids was noted. Hence, the treatment plan was changed to extract maxillary 1st bicuspids and mandibular 2nd bicuspids. This teeth extraction pattern will result in different anchorage requirement in the upper and lower arches. Because of the esthetic demands of patient, fixed lingual orthodontic treatment was applied in this patient. The progress of treatment will be detailed in the following text. 
Lingual Orthodontic Treatment in Adult Female with Angle Class I Malocclusion and Severe Crowding by Four Premolars Extraction: A Case Report.