Case Benova. Buccal surface of molars acts as the occlusal one.

Hi all! I need your ideas.

The patient is woman about 35 years old.
Problem list is mainly
Lingual inclination of lower molars, so that buccal surface acts as occlusal one.
Supraocclusion and overexpansion of upper molars
Shifted both midlines quite significantly to her right side.

With my occlusogram, there will be need for extraction of upper left first premolar.
Questions
How to start. By intrusion and constriction of upper molars?
How do you think I could upright the lower molars?
Can I use the tooth 24 before extracting for something?

Every help is highly appreciated

Hi Renata!
In my opinion, you need to start with the expansion of the upper arch, the derotation of the second molars and the intrusion of incisors. I think that the premolar is not useful, except for the displacement of 2.7 and 2.8 to the palatal side with the help of the cantilever. although in this case, the premolar will shift buccaly and the buccal surface of the alveolar process can be resorbed. Therefore, I think that the premolar is useless.
The question is what to remove 2.4 or 2.6, since 1.6 is missing to maintain symmetry. As for the lower molars, in my opinion it is necessary to upgrade them with the help of the canteliver from the premolars, which are combined with a lingual arch and connected to TADs.

During the discussion, other ideas may appear.

Hi Renata.
I take your occlusogram as correct, although we did not see face and smile.
I usually start to fix posteriors and use them later to correct the anterior teeth.
Before starting the treatment it would help to have an implant in region 3.7
You will need to raise the bite to correct the scissor bite, so I would use triad gel in the premolar area. So in this case, you could use a palatal arch to contract the upper 7.
However It is impossible to use normal lingual arches to expand the lower molars due to their inclination. You might use something like a lip bumper if she accepts it, otherwise you can try to use a LA without folding the terminal end between the implant and the right side.

I guess you will bring this case to the clinical discussion meeting

Thanks a lot! This will help.
There are pics of face above
I can bring this to the discussion force. And more Looking forward!