Orthodontist Reacts: Why Underwire Extrusions in This Stock Photo Are a Biomechanics Nightmare

Stock photos of medical procedures are notoriously inaccurate, but when it comes to orthodontics, some images show setups that are a total biomechanics disaster. If a patient walked into a clinic with their braces configured like this common stock image, it would immediately raise several major red flags for any licensed dentist or orthodontist.
First and foremost, a close look at the brackets reveals that the archwire is completely out of the slot on tooth number 10. This could simply be a case of a broken O-ring caused by poor hygiene or eating sticky candy, allowing the wire to pop out. Alternatively, it might be an intentional attempt at an underwire sling or an underwire extrusion technique. While running a wire underneath a bracket to force a tooth down can be used when gums are puffy and time doesn’t allow for a gingivectomy, it is highly inefficient if there is clear enamel available. In an actual clinical setting, it makes far more sense to just pop the bracket off and reposition it slightly lower toward the gumline.
Furthermore, using an underwire extrusion here makes no sense because the lateral incisors should never be longer than the central incisors. Because the wire isn’t seated in the slot, it completely ruins the necessary torque, kicking the entire tooth forward.
Beyond the messy wire placement, the image highlights a severe edge-to-edge bite. Leaving a patient with this type of occlusion creates a high liability for tooth wear and chipping. Relying on short-term emergency fixes like posterior bite turbos without a long-term plan to fix the underlying Class III relationship or negative overjet is simply sloppy mechanics. To achieve proper alignment, the clinician must establish a comprehensive plan using interproximal reduction (IPR) or elastics rather than relying on a broken, inefficient setup.