What should I do to correct my child's dentition?

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You have given excellent details for your case. As the signs enlisted and details of x-rays and photos attached (attachment removed to protect the patient's identity), you know that she does not have an aligned dentition. Your child is of growing age and still has the growth potential. So, as she grows more, her jaws will also increase, which will give space for teeth, and crowding for upper and lower jaws can be improved. Orthodontic treatment is needed to correct the conditions. As seen from the picture, she has a class 1 molar relation (and not class 2; however, photos can be deceptive and have parallax error at times). Considering it as a class 1 relation, it is normal and needs no attention. However, if it is towards class 2, still it is not much of a worry as she will be growing more and the lower jaw grows later than the upper one, which will bring molars to class 1 relations. So I am not concerned with molar relations as it will be coming to proper occlusion. Regarding midline concern, as you can see, her canines are still erupting, with one side more erupted than the other hence there is a shift in the midline. Once both canines have completely erupted, we will be able to assess them better, which can be easily managed under orthodontic treatment. I am concerned about the convex profile, prognathic maxilla and mandible, and protrusive upper and lower incisors. At times, even though molar relations are normal (class 1), the still patient develops a condition called "bimaxillary protrusion," wherein both upper and lower jaws are protruded compared to the upper face. However, that can be better assessed as she grows. Regular monitoring will help in that. Also, she still has deciduous teeth, which second premolars will replace, and second permanent molars are developing and will be erupting soon in about a year. Second premolars will help settle molar relations and crowding upto an extent, but second molars might push other teeth in front and cause crowding to worsen. Hence, a check on this aspect will be required. There are two options. Non-extraction protocol: We do not extract any of the permanent teeth in this approach and do the orthodontic leveling and aligning. But seeing the crowding and mal-alignment following a complete non-extraction protocol might result in a mild convexity at the end of the treatment. Suppose you are not satisfied with this approach. In that case, you can opt for "interproximal reduction," wherein the width of particular teeth is reduced, and space gained by that reduction is used for correcting the convexity. Extraction protocol: If she develops "bimaxillary protrusion" (chances are more but let us assess as growth continues), we might not give an excellent orthodontic treatment without extraction. Then, we have to opt for "All four extraction" (1st premolar extraction from all four quadrants) and then close the extraction spaces and achieve a good profile, eliminate the jaws prognathism, incisors protrusion, crowding as well as midline issues. She still has about two years of growth left based on the current radiograph image. We can initiate orthodontic treatment from now on; by the time her growth is complete, her orthodontic treatment will also be over with beautiful features and a smile. My suggestion would be start orthodontic treatment using the non-extraction protocol as of now. Continue the treatment as the canines and second premolars erupt completely. Based on the situation, decide whether to continue non-extraction, opt for IPR, or go for all four extractions. Natural dentition is the best asset. Do not unnecessarily extract in the initial phase. If the treatment requires extraction, you can get it removed later on. Try to save the tooth initially.