This patient lives on a boat, spending most of her time in the middle of the ocean with no access to care.
The patient is the daughter of explorers on a global climate mission and lives on a 50 foot aluminum sailboat traveling around the world climbing the highest peak on each continent.
She had a concussion and multiple traumatic injuries to her upper central incisors due to her activities on the boat in severe weather.
During the course of treatment she was caught in a storm and their sailboat/home was wrecked and the family had to be rescued.
The crowding, lip retrusion, and incisor retro-clination were addressed by dental expansion and advancement of the upper and lower incisors.
The patient had an upper right canine that was much more labial displaced than the left one. That was the same side that had a lingual displaced lower left first premolar
Both teeth had button cut outs and the patient used reverse cross elastics from the buccal of the upper right canine to the lingual of the lower right first premolar
The bite was opened by A) proclining the upper and lower teeth, B)Anterior bite turbos allowing posterior eruption in the presence of ramus growth (Relative Intrusion)
The elastics and the dis-occlusion helped the mandible grow favorably.
More space was opened on the right side to help make space for the impacted teeth on the right side and shift both mid lines to the left.
Power ridges were used to control the inclination of the upper and lower incisors.
Additional upper spaces were opened around the upper lateral incisors to allow for upper lateral incisor buildups.
The Initial round of aligners was discontinued at aligner 45 (out of 62) because multiple primary teeth had exfoliated and we wanted to to start the refinement before her next mission.
Two refinements (additional aligners) were needed to achieve the treatment goals.
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