Conservative treatment of palatally impacted canines

Abstract

M oving palatally impacted canines into their normal positions in the dental arch has frequently resulted in three unfavorable reactions: (1) apical resorption of the maxillary central and lateral incisors, (2) gingival irritation and recession of the maxillary first premolars, and (3) severe gingival recession of the maxillary canines. A treatment procedure has been developed to reduce the severit,y of these adverse conditions. In general, the procedure is as follows. Bands are first placed on all of the maxillary and mandibular teeth. In the patient whose case is shown here, 0.018 by 0.025 inch single edgewise brackets were used, with 0.015 inch leveling wires tied into all of the brackets. Multiple chain elastics are used when indicated to close spaces that may exist between the maxillary incisors. Extraoral traction is also placed to correct the Class II molar relationships and to help create sufficient space to accommodate the ranines. From 3 to 4 weeks later, the essential maxillary segmented wires are constructed. The maxillary incisors carry an 0.016 inch segmented arch wire wit,h “figure-of-eight” ligatures. The maxillary premolars and first molars carry 0.016 by 0.016 inch wires with mesiobuccal bayonet bends on the maxillary first molars to help establish secure anchorage. Headgear therapy is also continued. When the maxillary right and left first molars are somewhat overcorrected, multiple-chain elastics are placed from the maxillary right and left first molars to the second premola,rs, both facially and lingually, When the second premolars also are slightly overcorrected the brackets are secured with figure-of-eight ligatures. Multiple-chain elastics are then placed from the maxillary right and left first molars to the first premolam, facially and lingually. Extraoral traction is also continued. Maxillary segmented wires have been used during this procedure to avoid vertical “jiggling” of the anterior teeth. This also may help to avoid possible “brushing” of the maxillary incisor apices against the impacted canines tluring extraoral traction therapy. At this point, the mesiodistal space for the maxillary canines is usually suffi-