Not every case is treated to ideal for a variety of factors. In this case, the patient was presented with the ideal extraction pattern of UR5, LR5, UL4, LL5.
Since UL5 was root-treated, this tooth was the preferred tooth to extract in the upper left quadrant.
However, the patient decided she only wished to have one tooth removed, Ul5.
This meant that the occlusion on the left side would not be ideal. In addition, the centreline would be expected to drift to the left, which would be exacerbated by uprighting the distoangular UR3.
Control of the centreline would be a challenge. This was relayed to the patient, but it didn’t alter her decision. IPR on the upper right side helped to maintain the centreline.
An upper Nance appliance helped to hold the space once UL5 was extracted.