John presented at 14 years of age complaining of crowding and an instanding lower incisor. He had travelled over 200 miles in the hope of obtaining orthodontic treatment without extractions

There was marked crowding, with a lower incisor completely crowded out of the arch.

Treatment was begun with expansion of both the upper and lower arches, which were very contracted.

An upper ELSAA and lower Schwartz plate were used. These both have expansion screws, which the patient turns each evening.

Over several months, the appliances widen, creating space in the crowded arches as they do so.

After 4 months, fixed appliances were placed on the anterior teeth to straighten the incisors into the newly available space.

A compressed coil spring was used to open space for the very crowded lower left lateral incisor.

As the months went by, the improvement in alignment continued and the bite opened from its previously very deep overbite.Heavy rectangular wires were placed to torque the incisors into a good alignment.

The appliances were removed after 20 months of treatment, leaving an excellent result.

Fixed upper and lower retainers were placed to ensure the long term maintenance of the result.