Bracketless fixed orthodontic treatment with mandibular incisor extraction

As an alternative to the conventional fixed appliance that uses orthodontic brackets, a simple tube without a bonding base can be bonded by covering it with flowable composite resin. However, bracketless fixed treatment has been limited to nonextraction patients because rigid archwires cannot be used. In this report, a 23-year-old woman presented with the chief complaint of the reopening of the maxillary lateral incisor extraction space and the development of mandibular anterior crowding during retention. She was orthodontically treated with the extraction of the maxillary right and left lateral incisors and mandibular left central incisor 9 years ago. Spacing at the maxillary extraction site and mandibular crowding developed because of the lingual fixed retainer bond failure. She was diagnosed with a skeletal Class I with a one-quarter-cusp dental Class II relationship. The extraction of the mandibular right central incisor was planned to relieve the mandibular anterior crowding and increase the required overjet for retracting the maxillary central incisors to close the spacing. Simple tubes were bonded to the teeth instead of brackets. Stainless steel retraction overlay archwires were used to close the extraction space and apply Class II elastics. Overlays worked as a rigid archwire, preventing the bowing effect. After treatment, favorable occlusion was achieved. This case report demonstrates that bracketless fixed orthodontic treatment with simple tubes can be applied to patients undergoing mandibular incisor extraction with the aid of a rigid overlay archwire.