Dento-maxillary disharmony is a very common anomaly, often presenting aesthetic, occlusal, periodontal, and functional damage. The management of severe (DMD) cases often requires extractions of premolars and/or molars; however, certain clinical situations, such as agenesis and impactions of the incisors, require other extraction decisions. The extraction of incisors for orthodontic reasons is a therapeutic option that must remain exceptional in the context of a compromise treatment because the risks are not negligible. It is often a delicate choice with significant aesthetic and occlusal consequences. We will illustrate this by the case of a young patient who presented to the dentofacial orthopedics department at the CCTD for consultation with an ectopic maxillary canine. The clinical and radiographic examination showed that it was a Class I DDM case with the inclusion of the 32 and agenesis of the 42. The orthodontic decision consisted of a multi-bracket treatment with the extraction of the 14, 24, and 32 and coronoplasty of the canines and lower premolars. The management of space and occlusion made it possible to achieve a good aesthetic and functional result.
