# Mixed Dentition - Concerns of proximity of canine root to lateral

Hey everyone, looking for some input on this mixed case. Planning the first phase, expansion, addressing deep bite and then seeing if there is any resolution of the cl II. The concern I have is the 1.3 crown proximity to the 1.2 apex. I'm restricting 1.2 movement and expanding in the area of 5.3 /w some buccal root torque. We've discussed 5.3 exo. Any other additional suggestions to manage root resorption risk?


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# Answer

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Okay, so for this phase one case, the main concern is the position of the lateral incisors relative to the adult canines. Let's start by looking at the pan.


The canines are not at a steep angle, which is good for avoiding impaction. When looking at the CBCT, it shows that the canine is positioned more on top of the lateral incisor. I think the assessment here is correct—just avoid buccal root torque on the lateral incisor, and you shouldn't have too many concerns.


The pan does distort the angulation, but I would focus on expanding the arch and not allowing buccal root torque on the lateral incisor. At this point, you could either leave some space around the canines and plan to extract in a few years, or you could opt for extraction now. However, since this patient is quite young, I think giving it more time for the canines to come in naturally is advisable.


I would likely wait until the lateral incisors have descended a bit more. It will be easier to control those teeth when there's more exposure. Ideally, I'd wait about three more months, allowing the canines to come in more before working on correction.


Your plan of decompensating by proclining the central incisors is sound. Again, avoid buccal root torque on the laterals, flare out the central incisors, and expand to create more space. Align the lowers, intrude the lower incisors to correct the bite, and consider some Class II correction, particularly at night.

Once you start with elastics, focus on about eight months of full-time wear. You could start now, but since that tooth is quite high, it might continue coming in on its own. I prefer to let the body handle it naturally until it's time to intervene. If you wait three months and let the lateral come in, it will make the correction process easier.


Then, it's just a matter of working on Class II correction. Keep in mind that most of that correction won't happen until the patient is older, but you could start with nine months of early intervention. You could choose to extract the canines now or wait a year or two to evaluate the situation further. Either approach would be reasonable.