Treatment of class II malocclusion and unerupted upper canines with self-ligating appliance

Treatments without tooth extractions have become more popular over the last two decades. In this context, expansion of the maxillary arch is an interesting treatment option for cases in which space is required and other factors not favoring extractions (such as the facial profile) are present. According to several authors, this posterior expansion can be obtained using a system comprising self-ligating brackets and superelastic nickel-titanium arches. The present article aims to report a case of a young patient with Class II, Division 2 malocclusion, with impacted upper canines and significant arch length-tooth discrepancy. Methods: The case was treated by means of a passive self-ligating appliance in association with Class II elastics and coil spring for distalizing the molars. This treatment alternative was effective for correcting Class II and obtaining space to correct tooth positioning.

Controle por meio de tomografia computadorizada para tracionamento de caninos superiores permanentes não irrompidos – relato de caso / Using CT scan as control for the traction of unerupted permanent maxillary canines – case report

O objetivo deste relato de caso foi mostrar o tracionamento de caninos impactados em posições desfavoráveis numa paciente de 13 anos e 3 meses. Foram realizadas uma tomografia computadorizada e radiografia panorâmica inicial para averiguação da posição e angulação dos caninos. A tomografia mostrou o canino superior direito em posição horizontal em relação aos dentes adjacentes e localizado apicalmente, e o canino superior esquerdo, em uma angulação favorável para o tracionamento. A paciente foi encaminhada para extração dos caninos decíduos superiores direito e esquerdo. Em seguida, realizou-se a colagem do aparelho fixo superior com molas de secção aberta de aço inoxidável para obtenção do espaço suficiente para os caninos e, após, iniciou-se o tracionamento. Durante o tratamento ortodôntico, controles foram obtidos com tomografias após 11 meses de tratamento e dois anos pós-tratamento. Assim que ocorreu a irrupção parcial da coroa do canino superior direito na cavidade bucal, colou-se um botão, e com arcos de níquel titânio superelásticos, o dente foi tracionado lentamente (para não sofrer alterações de tecido mole) em direção ao arco dentário. Na finalização, a paciente utilizou elásticos intermaxilares para auxiliar o posicionamento correto no arco dentário. Os resultados obtidos foram muito satisfatórios considerando a angulação horizontal do canino superior direito na tomografia inicial, e obteve-se o correto encaixe dos dentes em Classe l de caninos com grande harmonia e estética.

The aim of this case report was to present the case of a 13.3 year old patient submitted to traction of impacted canine in a very unfavorable position. CT scan and initial panoramic radiograph were performed to determine the position and angulation of the canines. The CT scan showed tooth 13 in an apical position horizontally to the adjacent teeth. On the other hand, the tooth 23 was at a favorable angle for traction. The patient was referred for extraction of deciduous teeth 53 and 63. Then a fixed appliance with stainless steel open coil springs was installed to open space for the canines. After obtaining enough space in the arch, one closed coil spring was installed in the regions of canines to maintain the space and then start the traction. During orthodontic treatment CT scans performed at 11 months and again 2 years after treatment. As a part of the 13 crown erupted in the oral cavity, a button was installed and superelastic NiTi wire was used to slowly traction the tooth (not to suffer soft tissue changes) toward the arch. Following treatment, the patient wore intermaxillary elastics to aid in its final positioning. The obtained results were very satisfactory where in the initial CT scan tooth 13 was in an almost impossible angle for the traction to be performed. Proper occlusion of teeth in Class l canine relationship was achieved with great harmony and aesthetics.

Stability of interceptive/corrective orthodontic treatment for tooth ankylosis and Class II mandibular deficiency: A case report with 10 years follow‑up.

The purpose of this article is to present the treatment of a 8-year-old boy with tooth ankylosis in teeth 85 and Class II division 1 malocclusion and to report a 10-year follow-up result. The patient was initially treated with a sagittal removable appliance, followed by an eruption guidance appliance and braces. The interceptive orthodontic treatment performed to recover the space lost by ankylosis of a deciduous tooth allowed a spontaneous eruption and prevented progression of the problem. The use of an eruption-guidance appliance corrected the dentoskeletal Class II, thus improving the patient’s appearance. Besides the treatment producing a good occlusal relationship with the Class I molar, the correction of the overjet and overbite was stable over a ten-year period.