When the crowding is so severe that teeth need removal, but the patient wants other teeth removed instead.

This lady presented with severe crowding of her upper canines. She was mid 20s and had managed to get away with her smile without smiling.

The upper canines had barely any space to move into and she definitely needed 2 premolars removed. I mentioned removing the premolars next to the canines, but she wanted the premolars further behind removed, because they had big fillings already.

An easier option would have been to remove the canines and some people do go for the quick option.

The patient agreed with the removal of the second premolars and took impressions for Invisalign.

I asked for the second premolars to be removed and the teeth straightened on the Invisalign Itero scans. The simulation allowed me to assess the complexity of the treatment and the outcome of the movements.

I and the patient were happy with the outcome and agreed treatment.

The Invisalign aligners arrived and my nurse added plastic pontic teeth into the aligners where the teeth were going to be removed. We then removed the 2 teeth and aligners were fitted.

It took a while for a noticeable change as the first premolars had to move back into the extraction spaces before the canines could move.

After 18 months we finished treatment and we were all very happy. This lady was definitely one of my top 5 most favourite treatments due to the complexity and the fantastic results.