A 20-year-old female patient presented with the main complaint of missing teeth in the upper arch.
The clinical examination showed bilaterally impacted maxillary canines, with retained primary right canine, space deficiency, localized crossbite, and maxillary dental midline deviation.
CBCT revealed a palatal impaction of the right canine, with labial position of the left canine.
Treatment plan included :
- Space gain for 1.3 and 2.3
- Surgical exposure and orthodontic traction of impacted canines.
- Establishing a stable occlusion with acceptable anterior dental esthetics.
For retention, fixed retainers were bonded in the upper and lower dental arches.
The duration of treatment was 19 months.
Bibliography
Eslami E, Barkhordar H, Abramovitch K, Kim J, Masoud MI. Cone-beam computed tomography vs conventional radiography in visualization of maxillary impacted-canine localization: A systematic review of comparative studies. Am J Orthod Dentofacial Orthop. 2017 Feb;151(2):248-258. doi: 10.1016/j.ajodo.2016.07.018. PMID: 28153153.
Björksved M, Arnrup K, Lindsten R, Magnusson A, Sundell AL, Gustafsson A, Bazargani F. Closed vs open surgical exposure of palatally displaced canines: surgery time, postoperative complications, and patients’ perceptions: a multicentre, randomized, controlled trial. Eur J Orthod. 2018 Nov 30;40(6):626-635. doi: 10.1093/ejo/cjy070. PMID: 30321323.
Raghav P, Singh K, Munish Reddy C, Joshi D, Jain S. Treatment of Maxillary Impacted Canine using Ballista Spring and Orthodontic Wire Traction. Int J Clin Pediatr Dent. 2017 Jul-Sep;10(3):313-317. doi: 10.5005/jp-journals-10005-1457. Epub 2017 Feb 27. PMID: 29104396; PMCID: PMC5661050.
Lione R, Pavoni C, Noviello A, Clementini M, Danesi C, Cozza P. Conventional versus laser gingivectomy in the management of gingival enlargement during orthodontic treatment: a randomized controlled trial. Eur J Orthod. 2020 Jan 27;42(1):78-85. doi: 10.1093/ejo/cjz032. PMID: 31111882.
Forde K, Storey M, Littlewood SJ, Scott P, Luther F, Kang J. Bonded versus vacuum-formed retainers: a randomized controlled trial. Part 1: stability, retainer survival, and patient satisfaction outcomes after 12 months. Eur J Orthod. 2018 Jul 27;40(4):387-398. doi: 10.1093/ejo/cjx058. PMID: 29059289.
Pre-treatment panoramic X-ray
CBCT of the maxilla
CBCT , occlusal view
Pre-treatment, maxillary occlusal view
Ballista spring, closed surgical exposure.
E-chain
Change the position of the button
Alignment of canines
Post-treatment, fixed retainer.
E-chain
NiTi
Warren spring
Post-treatment, after gingivectomy
NiTi
Alignment of canine in the arch.
Post-treatment, left side
Post-treatment, frontal
Post-treatment panoramic X-ray
Pre-treatment, intraoral
Superimposition
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