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American Journal of Orthodontics and Dentofacial Orthopedics, 2022-05-01, Volume 161, Issue 5, Pages 616-617, Copyright © 2022 American Association of Orthodontists

Thank you very much for your feedback. We appreciate your comments and the opportunity to respond to some of the concerns that arose in your letter.

Several studies have evaluated the association between the proclination of mandibular incisors and the presence of periodontal problems. However, It has been reported that there is no sufficient high-level evidence to state that proclination of mandibular incisors could lead to periodontal problems. It has been suggested that this association will depend on other factors related to each patient, such as the gingival biotype, gingival thickness, the amount of keratinized gingiva, oral hygiene, brushing habits, smoking, among others. , , , Thus, an individualized evaluation of our patients should be performed before, during, and after treatment.

In addition, some studies have reported no significant correlation between proclination and gingival recession in the long term. , In this particular patient, the mandibular incisor showed labial inclination at pretreatment, but the patient also showed a good gingival biotype and adequate amount of keratinized gingiva, no gingival inflammation, adequate tooth brushing, and no smoking habits, allowing the performance of proclination of the mandibular incisors. The proclination in this patient was within the acceptable limits, , , , , and the patient´s periodontal conditions were monitored and maintained during and after treatment. Nevertheless, a long-term follow-up is mandatory.

Orthodontics gives us the chance to use different treatment approaches to achieve satisfactory results. We acknowledge the mentioned treatment alternatives, and we understand that treatment involving extractions and orthognathic surgery would provide great results with better chin position and more conservative incisor inclination/position. Nonetheless, the patient manifested her strong desire to avoid extractions and/or orthognathic surgery. Thus, other alternatives were proposed.

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Ideally, stability should be evaluated after a postretention period. , This period might be prone to relapse and maturational changes in the short and long term, respectively. Considering this, it has been reported that patients should wear retainers for as long as they want to keep their teeth in their corrected position. Otherwise, they must be conscious that there will be a relapse after orthodontic treatment and that the extent of relapse is unpredictable. , In this regard, long-term retention and all the care it involves were proposed. Again, a long-term evaluation of the patient is needed. Cone-beam computed tomography scans have not been used in this case report. However, these evaluations will certainly bring further information about the patient. This should be considered for future follow-ups and future patients.

Thank you very much for your comments.

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