Management of Atherton's patch for implant placement.
I have inherited this case midway through orthodontic TX. The case involves congenitally missing # 7,4 and 29 and anterior tooth size discrepancy. Implants had been treatment planned in site #7 and 29 with the canine moved distally from the # 7 position to its natural position. Space was not appropriated for #4 with the molars mesially positioned and the space opened for #29 by uprighting the lower right molars is now in excess of a normal bicuspid. There is a space distal to # 10 and the mesiodistal width between the canines and the centrals measures 7 mm on both sides. The patient is concerned about the Atherton's patch developed on distal #8 as a result of distalizing #6. Apparently the case was planned for orthognatic surgery to correct the occlusal cant due to unilateral condylar growth deficiency and shorted Ramus height, but the patient does not want to go through the surgery and just wants the ortho completed with the existing cant. I am eager to hear how the expert XP members would approach the esthetics anteriorly to manage the tooth size discrepancy and the Atherton's patch managment as it relates to implant placement in #7 position. The central incisors are 8.1 mm mesiodistally and the canines are 7.5 mm. # 10 is 5.7 mm M-D.