Case Report Initial Lateral Cephalometric Measurements Variable Norm Pre-Treatment SNA (º) 82.0 87.3 SNB (º) 80.0 83.8 ANB (º) 2.0 3.5 FMA (FH-MP) (º) 25.0 23.3 SN-MP (º) 32.0 27.2 4.0 2.3 104.0 104.0 U1-NA (mm) U1-SN (º) L1-NB (mm) 4.0 7.8 IMPA (L1-MP) (º) 90.0 90.5 Upper Lip-E Line (mm) -2.0 -0.3 Lower Lip-E Line (mm) -4.0 2.8 Treatment Options The patient refused traditional labial appliances, although she was willing to accept aligner therapy or lingual appliances. 1. Comprehensive orthodontic treatment: Mandibular first premolars, maxillary first right premolar, and maxillary left second premolar extraction. This would allow for reduction of the lower lip protrusion and correction of the right Class III malocclusion. This is very difficult to achieve with aligners due to the bodily movement needed; lingual appliances would be the choice here. 2. Comprehensive orthodontic treatment: One mandibular incisor extraction and maxillary anterior interproximal reduction (IPR). This could work nicely with aligners as well as with lingual appliances. 3. Comprehensive orthodontic treatment: Maxillary and mandibular anterior and posterior IPR. Significant IPR would be needed to create arch length, as Class III elastics would be needed to align the teeth and correct the bite; both aligners and lingual appliances could be used here. 4. Comprehensive orthodontic treatment: Mandibular arch retraction with temporary anchorage devices (TADs), maxillary IPR when necessary. Both aligners and lingual appliances could be used, but torque control on the mandibular incisors, as well as the distalization of the left mandibular segment, would be challenging. Lingual appliances would be the better choice here. Post-treatment description of Case H.M. begins on the next page. Spring 2018 PCSO Bulletin 39