Treatment of severe maxillary protrusion with bilateral agenesis of maxillary permanent canines: A case report

Background:Management of severe maxillary protrusion with tooth agenesis can be challenging and should be used with maximum anchorage to prevent loss of anchorage and improve the facial profile. 

Purpose: This case report aims to manage severe maxillary protrusion with bilateral agenesis of maxillary permanent canines using a non-extraction method. 

Case: This is a case report of an 18-year-old adult male with complaints of protruding and gapped front teeth. An intraoral examination indicated Angle's Class I malocclusion with maxillary protrusion, deep bite, multiple diastemas, 10 mm of overjet, 7 mm of overbite, deep curve of Spee, and retention of maxillary primary canines.

Management: Orthodontic treatment was performed using fixed orthodontic appliances pre-adjusted Roth 0.018 without extraction of permanent teeth. Orthodontic treatment included correction of maxillary protrusion and multiple diastemas, then continued with correction of deep bite and curve of Spee. After 1 year and 4 months of treatment, the goal of orthodontic treatment to correct the patient's aesthetics was achieved. Incisive inclination became normal, overjet and overbite became normal, curve of Spee approached flat, and lips became competent. 

Conclusion: Severe maxillary protrusion with bilateral maxillary canine agenesis can be treated by retaining the primary canines and using fixed orthodontic appliances without extraction of permanent teeth, followed by restorative management.