A 16-year-old boy came with the chief complaint of an unaesthetic dental appearance. His first maxillary premolars were extracted prior to the consultation, mandibular canines were peiodontically compromised with the absence of attached gingiva and the presence of severe anterior crowding.

Treatment included extraction of both mandibular canines and first maxillary molars to correct anterior crowding. The case was treated successfully with orthodontic space closure and the substitution of the premolars into canines.

Our main treatment objective was: Restoring a functional occlusion, by treating anterior crowding. Improving the periodontal environment, thus extracting both mandibular canines bringing healthy premolars, with better periodontal tissues, to take place.

The mandibular first premolars were substituted for the canines. After 26 months of active treatment, the patient had a Class I molar relationship and ideal overbite and overjet. His profile was improved, lips were competent, and gingival levels were acceptable. Cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations.