PMC9076339_01
Pretreatment facial and intraoral photographs.
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Extraoral examination revealed a symmetrical and well-proportioned face pattern with a straight profile (Figure 1). The intraoral examination presented good oral hygiene with less attached gingiva at the upper canine area (Figure 1).
Pretreatment dental casts.
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The interarch relationship was an Angle Class I molar relationship bilaterally, with 40% overbite and 4 mm overjet (Figure 2).
PMC9076339_02
Pretreatment panoramic radiograph.
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On radiographic examination, there was a complete transposition of the crowns and the roots of the maxillary canine and first premolar (Max.C.P1) bilaterally, and with the roots of the canines were straight (Figure 3).
The lateral cephalometric radiograph.
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The lateral cephalometric analysis revealed that, in this patient, there was a skeletal Class I relationship (A point, nasion, B point (ANB) angle = 2 ) with normal upper and lower incisors (Figure 4).
Initial cephalometric tracing.
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During the bonding procedure, the first premolar crowns were bonded with the canine bracket to achieve the canine prominence (Figure 5).
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Initial cephalometric tracing.
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During the bonding procedure, the first premolar crowns were bonded with the canine bracket to achieve the canine prominence (Figure 5).
Banding and bonding (upper and lower preadjusted edgewise fixed appliances with MBT prescription and 0.022'' x 0.028'' slot size bracket) and placement of the initial leveling and aligning archwires (0.014 superelastic nickel titanium).
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In the initial phases of treatment, the permanent molars were banded, and upper and lower preadjusted, edgewise, fixed appliances with MBT prescription (3 M gemini MBT 0.022'' x 0.028'' slot size brackets) were placed (Figure 6).
Nitinol coil spring between upper and second premolar.
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In the maxillary arch, to provide room for the canine teeth, a 0.018 stainless steel archwire with a Nitinol coil spring was placed between the first and second premolars (Figure 7).
Powerchain from the upper right first premolar to left first premolar to close diastema.
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Along with closing the diastema and moving the upper first premolars into the canine position, we used a power chain on braces from the right first premolar to the left first premolar (Figure 8). Steel colligation was used on the upper first and second premolars to avoid teeth rotation (Figure 8).
Piggyback 0.012 NiTi over 0.018 stainless steel archwire to bring the right canine to the arch.
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After 12 months, piggyback 0.012 NiTi over 0.018 stainless steel archwire was placed to bring the right canine to the arch in the position of first premolar (Figure 9).
Both upper right and left canines included.
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Both upper right and left canines were then included from 0.014 NiTi archwire up to 0.019 x 0.025 stainless steel archwire, with palatal root torque at the canines (Figure 10).
L-shaped elastic chain from lower canine to upper molar on both sides.
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Power chain was used from the mandibular right first molar to the left first molar, and an L-shape elastic chain (1/4 3 M medium force 4 oz) from the lower canine to the upper molar on both sides (Figure 11).
PMC9076339_05
Posttreatment clinical photographs and lateral cephalogram.
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After 36 months of active treatment, the maxillary and mandibular fixed appliances were removed and the posttreatment records such as a panoramic radiograph (Orthophos XG), cephalometric X-rays (Orthophos XG), impressions, and photographs (Canon mark II with 90 mm macrolens) were taken to assess whether the treatment objectives were achieved (Figures 12 and 13).
Final cephalometric tracing.
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After 36 months of active treatment, the maxillary and mandibular fixed appliances were removed and the posttreatment records such as a panoramic radiograph (Orthophos XG), cephalometric X-rays (Orthophos XG), impressions, and photographs (Canon mark II with 90 mm macrolens) were taken to assess whether the treatment objectives were achieved (Figures 12 and 13).
PMC9076339_06