Am J Orthod Dentofacial Orthop 2016;149:307 0889-5406/

When is Enough Enough

Mrs Kim is a cheerful 63-year-old who has been agreeable to any treatment plan you have proposed. Her initial presentation was complex. Her maxillary left canine was extracted in adolescence; consequently, there was a significant maxillary-to-facial midline discrepancy of 4 mm. Bilateral fixed bridges have replaced the absent mandibular first molars. The patient had mild bimaxillary protrusion, with facial convexity that only slightly exceeds ethnic norms. Despite Mrs Kim’s lip incompetence, few would have considered her unattractive. To add to the treatment complexity, there was 50% generalized crestal bone loss that preexisted her treatment course, but her periodontist considered her status to be stable. Also of note is her long-term use of oral bisphosphonates to treat osteoporosis.

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