The upper teeth are jaw are a long way forwards compared to the lower teeth and jaw in this growing patient – we call this a Class II dental and skeletal relationship. All 4 of her adult first molar teeth were compromised due to hypomineralisation / hypoplasia. If you treat patients during the growth spurt you can improve the Class II dental relationship by camouflage. You can’t easily change the Class II skeletal relationship (except with jaw surgery). The 4 adult first molar teeth were removed as the wisdom teeth are forming and, if we leave the first molar teeth they will need a lot of dental treatment in the future.