Orthodontic Space Closure and Third Molar Uprighting for Simultaneous Maxillary and Mandibular Molar Loss on the Same Side

This case report describes the successful non-surgical orthodontic management of a complex Class I malocclusion characterized by unilateral posterior tooth loss and functionally induced facial asymmetry. A 28-year-old male patient presented with a non-restorable maxillary first molar (#26) and a missing mandibular second molar (#37). The resulting occlusal discrepancy contributed to a mandibular functional shift and facial asymmetry. The patient declined prosthetic and surgical options, prompting a conservative orthodontic approach. The treatment plan incorporated third molar protraction and upright to substitute for the missing second molar, combined with occlusal rehabilitation to correct the asymmetry. Space closure was achieved using elastic chains, and intermaxillary elastics (IME) were employed to improve intercuspation. The Low Hysteresis super-elastic Ti-Ni alloy wire developed by Tokyo Medical and Dental University played a key role in achieving controlled tooth movement and space closure. Upon completion, the patient exhibited well-aligned dental arches, optimal overbite and overjet, and a marked improvement in facial symmetry. This case highlights the effectiveness of a minimally invasive orthodontic approach for managing complex malocclusions involving unilateral molar loss—achieving functional and esthetic improvement without surgical intervention.