PMC4299428_01
Patient's initial photograph showing fixed appliance set with transposition
between the upper left canine and lateral incisor, and the absence of upper
central incisor on the same side.
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Clinical examination revealed that the patient had permanent dentition with Angle Class II malocclusion on the left side due to migration of the posterior superior segment to a more anterior position; Class I malocclusion on the right side; upper midline deviation to the left; absence of tooth #21 with bulging in the vestibular region just below the anterior nasal spine (ANS), lack of space for its eruption, and transposition between teeth #22 and 23 (Fig 1).
Occlusal radiograph revealing impaction of tooth #21 with complete root
formation.
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Its root was fully formed (Fig 2) and had the coronal long axis in a more horizontal position between the middle and apical third of the adjacent teeth roots (Fig 3).
Lateral cephalogram revealing impaction of tooth #21 with coronal long axis
horizontally positioned between the middle and apical third of adjacent teeth
roots.
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Its root was fully formed (Fig 2) and had the coronal long axis in a more horizontal position between the middle and apical third of the adjacent teeth roots (Fig 3).
Panoramic radiograph revealing impaction of tooth #21, #22 and #23 with incomplete
transposition.
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Incomplete transposition between teeth #22 and 23 and image overlap of tooth #22 root apex and tooth #21 root were confirmed (Fig 4).
Intraoral photographs with fixed appliance removed and new bands with triple tubes
properly cemented. A) Right lateral view. B) Frontal view. C) Left lateral
view.
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After removal and prophylaxis, new bands and weld of upper triple tube and lower double tube were prepared, in addition to cementing them on the upper and lower first molars (Fig 5).
Intraoral photograph showing fixed appliance: A) Right lateral view. B) Frontal
view and C) Left lateral view with TMA semiarch for #23 intrusion.
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Thereafter, the fixed metal orthodontic appliance was set with 0.018 x 0.030-in slot in both arches, semi-arches of stabilization with blue 0.016 x 0.016-in Elgiloy wire on the lower right and left sides as well as on the upper right side, an utility arch (UA) in the lower arch, and, on the upper left side, a semi-arch with helicals for intrusion of tooth #13 with TMA 0.017 x 0.025-in wire, with intrusive force of 45 grams to attempt dental transposition (Fig 6).
Hilgers appliance properly installed.
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After two days, the Hilgers appliance was installed for upper left molar distalization and anchorage of the upper premolars on the same side, thus, avoiding extrusion (Fig 7).
Quad-helix appliance installed to maintain distalization of #26.
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The Hilgers appliance was removed and a quad-helix appliance (QH) was installed with 0.90 mm stainless steel wire to anchor and maintain upper left molar distalization (Fig 8).
Distalization of tooth #23 with closed NiTi spring and mesialization of #22 with
open NiTi spring.
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A semi-arch with rectangular 0.017 x 0.025-in stainless steel wire with 3/16-in medium elastic was also installed (Fig 9).
Upper arch alignment after transposition.
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After transposition was completed, alignment and leveling were performed with 0.014-in NiTi wire (Fig 10) up to the 0.016 x 0.016-in square stainless steel wire for better stabilization.
Upper arch with open steel spring used to keep the space left for traction of
retained tooth #21.
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An open steel spring was used between teeth #11 and 22 to keep the recovered space that would be occupied by tooth #21 (Fig 11).
Traction of tooth #21 carried out with 0.014?/span> NiTi wire superimposed to
0.016 x 0.016-in square stainless steel archwire with open spring between #11 and
#22.
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After 10 days, the sutures were removed and traction of tooth #21 began with 0.014-in NiTi wire superimposed to the square stainless steel archwire with open spring, by applying low magnitude forces in order to prevent unwanted movement of the adjacent teeth (Fig 12).
Final intraoral photographs: A) Frontal view with Hawley retainer. B) Occlusal
view of upper arch with fixed retainer from tooth #11 to 23. C) Lower occlusal
view with fixed lingual arch.
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As for the lower dental arch, a fixed lingual arch fabricated with 0.80 mm stainless steel wire was adhered to the lingual surfaces of lower canines, with light-cured resin (Fig 13).
Final intraoral photographs: A) Right lateral view. B) Frontal view. C) Left
lateral view.
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The case has been finalized and it is currently under clinical (Fig 14) and radiographic follow-up (Fig 15).
Final panoramic radiograph.
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The case has been finalized and it is currently under clinical (Fig 14) and radiographic follow-up (Fig 15).