THE EDITOR'S CORNER
One condition that I hate to see come into the office is any case with narrow width upper lateral incisors. Often enough you can spot them immediately. Others may turn up if you do a Bolton size analysis. Still others may not become obvious until treatment is under way or completed.
The thing that's wrong with these cases is that they can rarely be right. The most frequent post-treatment problem will be spacing in the upper anterior section. What can you do about it? We know what to do if the laterals are missing altogether. And we have little compunction about extracting tiny, underdeveloped laterals. And we often will recommend making jackets for peg-shaped laterals with satisfactory roots. But, we never seem to think in terms of jacketing laterals that are of normal contour but narrow in width. Yet, that is probably the answer to this annoying problem.
The alternative answers are usually unsatisfactory. You sometimes will retract to an edge-to-edge bite and retain for a longer-than-average period hoping that it will hold, or that there will be some slippage of the Class I correction. However, they usually do neither one. They merely space out. In any event neither such a relapse to a slight Class II relationship nor an incomplete correction in the first place is as good an answer as achieving a proper result and having jackets made for the laterals to take up the excess space.
Sometimes you see a closed upper arch in a Class I relationship with crowding in the lower anterior section. This may be a compensation for the narrow upper laterals. And, it may be possible to solve this by stripping the lower anterior teeth. However, the impression that I have of my success with stripping lower anteriors is that it is not so great as to justify this as a form of treatment for this problem. I would opt for jacketing the narrow upper laterals.
When should these jackets be made? Most often the best time would be after treatment. You do have the added problem of placing the laterals in the middle of the central-to-cuspid space, but this is not too difficult. On the other hand, if you try to prescribe jackets prior to treatment or early along in treatment, you have the added responsibility of deciding just what the width of the lateral jackets should be and the added hazard that the dentist might not make them exactly as wide as you prescribed. In addition, if there is any question of poor esthetics of the jackets due to bulk or color, you are less a party to that criticism if the jackets are done after your work is completed.
The overriding reason for recommending that the jackets be made after treatment is the fact that you can position the other teeth correctly and all the dentist has to do is to fill the space that remains. This is simpler and surer than trying to predict even with accurate measurements what the width should be.
One final thought. No matter how you plan to handle the problem, it is far better to have some routine step in your diagnostic procedure to identify the problem before treatment, than to find out about it after treatment. You may have a lot of explaining to do, you will make a lot of extra work and worry for yourself, and most often you will get upper anterior spacing with such an esthetic detriment that you will have a failure in an otherwise well-treated case.
A suggestion is to review Wayne Bolton's classic paper which appeared in the July, 1958 issue of The Angle Orthodontist and routinely to use his formulas or an Odontorule or similar device to identify these discrepancies. It takes less than five minutes to do this analysis by any method and it can be done by your assistant.
If you do this routinely, you are going to find frequent discrepancies over a whole range from insignificantly small to significantly large. What this does is to permit you to point out this hidden problem in your case presentation and to suggest, before treatment the possibility or likelihood that it may be necessary to recommend jacketing the upper lateral incisors to achieve an esthetic result. 
