Retreatment of a Failed 4-Bicuspid Amputation, Retraction Orthodontic Case

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By Gerald H. Smith, DDS, DNM

This case presents the concept for the necessity to establish architectural balance when correcting distortions of the maxilla and iatrogenic malocclusions. Since the maxilla represents the anterior two-thirds of the base of the human skull and the fact that it directly affects the balance of the rest of the cranial bones and dural membrane system, dental orthopedic corrections must re-establish a neutral position in order to alleviate chronic pain.

IH is a 28- year old male patient who came into the practice after reviewing case studies on ICNR’s website.


  • “ I have chronic neck pain for the past 14 years.”
  • “ I experience chronic fatigue.”
  • “ I have lower back pain.”
  • “ I experience mental fog.”
  • “ I experience head and neck tension.”
  • “ I had a loss of athletic skills.”
  • “ I had a loss of reading comprehension and mental processing skills.”


  • Maxillae rotated counter-clockwise.
  • Maxillary left quadrant of teeth were mechanically moved forward.
  • Left half of the maxilla was compressed.
  • Loss of vertical dimension.
  • Retrusion of the maxillary six anterior teeth.


Distortion of the maxilla results in compression of the cranial bones, sutures, torquing the entire cranial vault and dural membrane system down to the second sacral tubercle. Loss of vertical dimension causes compression of the spinal vertebrae.

  • Left temporal bone internal rotation.
  • Right temporal bone external rotation.
  • Right amplitude was weak.
  • Left greater wing of the sphenoid was high.
  • Reversed sphenobasilar motion with diaphragmatic breathing.
  • Positive Shock Point.
  • Decreased vertical.
  • Maxillary six anterior teeth were distalized compressing the premaxilla into the maxilla, the maxilla into the palatine bones and the sphenoid.


  • Cranial manipulation to reset the reversed sphenobasilar motion.
  • Nutritional support for the weak adrenals and immune system.
  • Advanced Lightwire Functional appliances to correct the counter-clockwise rotation of the maxilla, decompress the cranial vault and other cranial distortions.
  • Conventional orthodontics to correct alignment of teeth and establish cranial balance.

ALF elastics

  • Neck pain totally resolved.
  • Chronic fatigue totally resolved.
  • Lower back pain totally resolved.
  • Mental fog totally resolved.
  • Head and neck tension totally resolved.
  • Golfing skills totally restored.
  • Mental acuity and processing restored.

The patient’s video testimonial is available here.


Ian Completed Case 2

Ian Completed Case 3

Ian Completed Case 4

Ian Completed Case 5

Ian Completed Case1


The ALF (Advanced Lightwire Functional) appliances have evolved into a sophisticated delivery system.  The biggest missing link in orthodontics has been the occlusal cranial connection. The ALF appliance System provides the vehicle for connecting these two components.

In 1995, this author introduced the diagnostic Occlusal Indicators to guide practitioners in the adjustment of the ALF. Four simple indicators, which are easily palpable on the patient’s skull quickly determine the pre-existing three-dimensional distortions. By judiciously adjusting the ALF appliance, the Cranial Indicators are manipulated by the appliance into a neutral position. The indicators tell the practitioner where the cranium is before, during, and after treatment. Completion of ALF treatment is achieved when the dental arches are adequately developed and removal of the ALF appliance allows all four of the cranial indicators to remain in balance (neural position). The process is simple, non-invasive, accurate, and quickly carried out.

The occlusal cranial problems presented by this patient can only be observed by practitioners who have the understanding of the cranial occlusal complex and can interpret the three-dimensional distortions that exist.

Retreating four bicuspid amputation and retracted orthodontic cases are one of the most challenging exercises in orthodontics. However, using the Cranial Indicator Diagnostic System makes the process easier.


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