Sharing a case here where severe crowding in both the upper and lower arches were treated with 1st Premolar extractions in the 1st, 2nd and 3rd Quadrant and 2nd Premolar which was impacted in the 3rd Quadrant..
Most importantly, we know that moving canines into position is very challenging due to the unwanted reactionary forces that we encounter..
Newton’s first law.. Every action has an equal and opposite reaction..!
Hence in this case, in order to simplify matters, driftodontics was used. Ie, after the extraction of the 1st Premolars, the canine’s were simply allowed to drift for 5 months.
The second photograph in the treatment series shows the point at which the canines were bonded and engaged. Note that they are now at a far more favourable position.
Driftodontics also has the benefit of achieving the best possible periodontal health of the canines.
In hindsight, one error on my side was that I should have placed a Nance Palatal Arch and a Lingual holding arch in the upper and lower arches respectively. This would have prevented some of the mesial drifting of the posteriors as was seen in this case. None the less, an excellent result has been obtained.
Frontal View showing 3 impacted canine's.
Right Lateral View.. note the difficult angulation of the lower right canine..
Left lateral View.. note the missing lower 2nd premolar..
Note the significantly improved positions of the canine after 5 months of drifting.. Here only the canine's and molars are engaged initially to minimize intrusive forces on the centrals and laterals..
Slowly the anteriors are also engaged..
to help create space for the lower 1st premolar on the left side.. which was partially impacted, open coil spring was used..
As enough space was created for the lower premolar.. it was now engaged.. note that by now the upper arch has been aligned well..
Excellent development of the occlusion has been achieved with good intercuspation...
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