Case Report Initial Lateral Cephalometric Measurements Variable Norm Pre-Treatment SNA (º) 85.4 84.9 SNB (º) 80.6 81.2 ANB (º) 4.8 3.6 FMA (FH-MP) (º) 24.7 17.1 SN-MP (º) 31.5 29.0 6.3 8.0 108.3 115.1 U1-NA (mm) U1-SN (º) L1-NB (mm) 10.4 11.9 103.1 106.5 Upper Lip-E Line (mm) 5.0 0.4 Lower Lip-E Line (mm) 3.0 4.0 IMPA (L1-MP) (º) The norms are based on African American norms. Initial panoramic radiograph and lateral cephalogram Treatment Options 1. Exposing and bringing all of the impacted teeth into the arch. 2. Considering the complexity, time, and risk factors involved in bringing multiple impacted teeth into the arch, another option was presented to the patient. This would involve the extraction of the permanent canine, exposure of the UL1 only, and retention of the ULC for as long as possible. It would reduce taxing the neighboring teeth during treatment and minimize the restorative needs for the patient. 32 3. The final option would involve extraction of the impacted teeth and a restorative alternative to address the edentulous spaces, or multiple premolar extractions. Even though dental implants could be an option to restore the missing teeth, it would not be an attractive choice in this case, considering the esthetic zone and the difficulties involved in achieving great esthetic results. Post-treatment description of Case D.M. begins on the next page. PCSO Bulletin Summer 2017