PMC5075292_01
Initial documentation: profile photo (a); frontal photo (b); frontal photo with smile (c); intraoral photos: right, (d) frontal (e), and left side (f).
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Clinical examination showed symmetrical and proportional face, straight and harmonious profile, passive lip closure, suitable smile line (Figures 1(a)-1(c)), Angle Class I occlusion, matching media lines, normal overjet and overbite, mixed dentition with presence of the element 53, and the absence of its successor 13 (Figures 1(d)-1(f)).
Initial documentation: study models showing a suitable arch shape and a good occlusal relationship.
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The models confirm the occlusion in Angle Class l with parabolic arches and suitable overjet and overbite (Figure 2). In Figure 6, the result after 2 months of NiTi wire use is observed.
Initial documentation: exams imaging for diagnosis of impacted canine. (a) and (b) are periapical radiographs with Clark technique (note that in (b) the tooth moved distally, indicating its position by palatal); red arrow indicates the impacted tooth (c).
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Through Clark technique, the palatal position of the canine was observed (Figure 3).
Intraoral photographs. Access to the impacted tooth through open surgery (a). The arrow points to the cantilever made from the transpalatal arch extension; cantilever in TMA coupled to the auxiliary band tube (b).
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At the end of this arm, the extrusion force directed to impacted tooth was applied (Figure 4). After mounting of the anchoring system, the patient underwent surgery for bonding orthodontic button. However, the accessory became unglued during traction and an open tunnel surgery was performed to guide the tooth trajectory with an orthodontic bracket placed on the exposed crown (Figure 4(a)). A second cantilever, made with TMA wire (0.017'' x 0.025''), was coupled by buccal to maximize the biomechanics effects (Figure 4(b)).
Intraoral photographs. Mechanism of action of the two cantilevers acting together (a). Removal of the transpalatal arch and cantilever coupled to the tube (b). Bypass in the region of upper right canine and round wire assisting in the mechanical forces (c).
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After traction, controlled with the aid of cantilevers (Figures 5(a) and 5(b)), the final positioning of impacted tooth was performed using a rectangular rigid steel wire (0.017'' x 0.025'') containing a bypass for canine region. Thus, a round wire of NiTi (0.016) was added to the system of forces, causing minimal side effects and helping the canine to achieve the optimum position (Figure 5(c)).
Intraoral photos after 2 months of using the NiTi wire (0.016).
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In Figure 6, the result after 2 months of NiTi wire use is observed.
Photos immediately after removal of the appliance.
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 Figure 7 shows the end result of orthodontic treatment.
Final radiographs. In panoramic radiography, good positioning of all erupted teeth and parallelism of roots are observed (a); in teleradiography it is noted good maxillomandibular relationship as well as between the upper and lower incisors (b).
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In the radiographic evaluation (Figure 8), the normality of tooth positions is noted, in addition to satisfactory standard facial.