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Initial clinical radiographic records. (a) Facial and intraoral photographs. (b) Lateral X-ray. (c) Cephalometric tracing. (d) Panoramic X-ray: right canine: impaction sector 5 (close to the midline, adapted from Ericson and Kurol); impact level: middle root third; angle between the longitudinal axis of the canine about the midline: 54.1 ; angle between the longitudinal axis of the canine and the longitudinal axis of the adjacent lateral: 55 ; distance from the cusp of the canine to the occlusal plane: 12.4 mm. Left canine: impaction sector 5 (close to the midline); impact level: middle root third; angle between the longitudinal axis of the canine in relation to the midline: 55.4 ; angle between the longitudinal axis of the canine and the longitudinal axis of the adjacent lateral 53.8 ; distance from the cusp of the canine to the occlusal plane: 14 mm.
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fig1
The patient also presented a class I angle malocclusion, with no evidence of crowding and coinciding midlines (Figure 1). The permanency of the deciduous mandibular canines with no root resorption was confirmed (Figure 1). The longitudinal axis of the right canine with relation to the midline presented a 54.1  angle, and with relation to the longitudinal axis of the adjacent lateral incisor of 55 , with a distance from the occlusal plane of 12.4 mm; the left canine presented 55.4  with relation to the midline, 53.8  with the longitudinal axis of the adjacent lateral incisor, and a distance from the occlusal plane of 14 mm, located more buccally than the right canine (Figure 1).
(a) Fixed device for temporary anchorage. (A) Lingual arch main support in 1.1 mm SS wire. (B) Prefabricated metal bands with lower first molar tubes. (C) Vertical hooks in 0.028'' SS wire, with bends towards the distal direction. (b) Trans-surgical radiographic and clinical records. (c) Three months of traction. Radiographic and clinical records.
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fig2
This was adapted to the lingual surface of the mandibular teeth, with proximal occluso-buccal extensions (SS 0.028'', Dentaurum, Ispringen, Germany) from canine to molar with the hooks in the distal direction on both sides of the dental arch (Figure 2). Approximately 100 g of force was used to achieve traction of the tooth (Figure 2).
(a) Images of the first phase. Radiographic and clinical records. (b) Records of the start of the third phase of treatment.
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fig3
The third and final phase of the treatment started 18 months after the first visit, with a collection of clinical and radiography data (Figure 3).
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(a) Images of the first phase. Radiographic and clinical records. (b) Records of the start of the third phase of treatment.
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fig3
The third and final phase of the treatment started 18 months after the first visit, with a collection of clinical and radiography data (Figure 3).
(a) Six months after the start of the third phase. (b) One year after initiating the third phase.
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fig4
Additionally, an Australian 0.016'' arch-wire for anterior extrusion in the upper arch was used (Figure 4). Based on the transaxial slices and to move the canines in a lingual direction, set bends were made to incorporate the canine roots into the alveolar process (Figure 4).
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Extra-oral and intra-oral photographs and final radiographic-cephalometric records.
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fig5
The clinical records showed adequate dental arch form, good inter-arch engagement, ideal overjet and overbite, and coinciding midlines, as well as an acceptable facial profile with few variations (Figure 5). A lower lingual fixed retainer was adapted from canine to canine (Figure 5).
(a) Pre-treatment tomographic images. (b) Intermediate tomographic images showing the absence of buccal cortical at the level of the mandibular canines. (c) Post-treatment transaxial tomographic slices of lower incisors. (d) Superimposition of initial and final phase tracings.
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fig6
In the cephalometric examination, the mandibular incisor inclination had a similar position, whereas the inclination of the upper incisors had moderately increased (Table 1; Figure 6).