MBT Prescription Research Articles

Treatment of severe skeletal Class III patient with buccally impacted canines and severe crowding using a bone-anchored facemask and Alt-RAMEC protocol: A case report

A 14-year-10-month-old female patient presented with a chief complaint of being dissatisfied with the looks of her teeth and face. She had a pronounced misalignment of her dentition, defined by a Class III skeletal relationship and an average vertical proportion of the face. The patient had an anterior crossbite and bilateral posterior crossbites, with the upper left canine impacted in a buccal position. After a comprehensive consultation with the patient and her parents, we decided to implement a treatment strategy that entailed utilizing a maxillary bone borne expander in conjunction with a facemask. This treatment followed a protocol that consisted of alternating between rapidly expanding and contracting the maxilla. The purpose of this was to stimulate the advancement of the midface. After the treatment was carried out to treat the crossbites, a fixed appliance (MBT prescription) was bonded on the maxillary and mandibular arches. In addition, four premolars were extracted, and the upper left canine was brought to occlusion. Temporary anchorage devices were used in the lower arch to provide skeletal anchorage. The patient underwent active treatment for a period of 24 months following which we were able to achieve satisfactory occlusal and esthetic results.

Orthodontic Camouflage For Class II Malocclusion: A Case Study Using Miniscrew Implants And Strategic Extractions

This case report describes the orthodontic treatment of a 21-year-old Caucasian female patient with a Class III incisor relationship on a Class II skeletal base and increased vertical proportions. The patient presented with severe crowding in both upper and lower arches, gingivitis, molar incisors hypomineralization, and extensive caries in the LL6 tooth. She also exhibited decreased overjet, a complete overbite, and a significant shift in upper and lower dental midlines. The primary objective of treatment was to correct the malocclusion through orthodontic camouflage, which involved the extraction of upper and lower first premolars on the right side and first molars on the left. Miniscrew implants were utilized to enhance anchorage. Fixed appliances with a preadjusted MBT prescription were employed for alignment and leveling of both arches. The treatment resulted in improved occlusion, correction of midlines, and resolution of the patient’s aesthetic concerns. The case underscores the efficacy of orthodontic camouflage in managing complex malocclusion cases in adults while avoiding surgical intervention.

Evaluation of the Conventional Acid-Etching System and the Self-Etching Primer in Bonding Metallic Orthodontic Brackets: An In-Vitro and In-Vivo Study.

This study aimed to compare the shear bond strength (SBS) of enamel-bonded orthodontic brackets with the conventional acid etching (CAE) system and the self-etching primer (SEP)in vitro and to compare the clinical performance of both systems when used in the treatment of malocclusion patients. In the first part of the study, 40 extracted human premolars were randomly divided into two groups containing 20 teeth. The first group (the conventional enamel etching group) employed37% phosphoric acid before bonding the metallic brackets (0.022-inch slot, MBT prescription, American Orthodontics, Sheboygan, WI, USA). The etching system wasTetric 5th (Ivoclar Vivadent, Schaan, Liechtenstein). The second group used a SEP (Sep Tetric 7th, Ivoclar Vivadent, Schaan, Liechtenstein) to bond the same brackets. In the first part of the study, SBS was evaluated, followed by the adhesive remnant index (ARI) assessment. The second part of the study (i.e., the clinical part) assessed a cohort of 30 patients during a 6-month observation period. The upper 10 teeth (from the second premolar on the right side to the second on the right side) were bonded using the chosen method for each patient in the clinical assessment. That is, 150 teeth in each group were evaluated regarding the failure rate. The ARI was assessed for those teeth that lost their brackets. The mean SBS was greater in the SEP group compared to the CAE group (17.93 MPa and 16.60 MPa, respectively; P = 0.014). The difference was not statistically significant. Conversely, the failure rate was lower in the CAE group compared to the SEP group, with a failure rate of 6% and 14.7%, respectively. The difference was statistically significant (P = 0.014). However, the ARI showed no statistically significant difference in in-vivo and in-vitro analyses, as most bracket failures were at the adhesive level. Laboratory results showed no statistical difference in the SBS mean values between the two groups. Clinically, the SEP group showed a greater failure rate than the CAE group, but both failure rates in the two groups were within the clinically acceptable range. The ARI did not show any difference between the two groups in terms of the failure site when the evaluation was conducted in vivo and in vitro, as most of the areas of failure were concentrated in the material itself.

Pain Perception, Knowledge, Attitude, and Diet Diversity in Patients Undergoing Fixed Orthodontic Treatment: A Pilot Study.

This study aimed to determine the correlation between pain perception and knowledge, attitude, and diet diversity in patients undergoing fixed orthodontic treatment. A total of 103 patients (15-40 yrs.; 67 females, 36 males) undergoing orthodontic treatment with a 0.022-inch slot (MBT prescription) in both arches were recruited. Information on pain perception, knowledge, attitude, and diet diversity scores was collected through validated questionnaires using visual analogue scale and close-ended questions at one time point. The correlation between variables was analyzed using the Pearson's correlation coefficient. Of the patients, 48.5% were aged 15 to 19 years old, with 65% females and 73.8% of Chinese ethnicity. Approximately 90% of the orthodontic patients perceived low levels of pain from orthodontic treatment, and 98% had a positive attitude toward orthodontic treatment. The patients had a good level of knowledge (Mean: 6±0.65). Approximately 49.5% of patients reported having moderate diet diversity. No significant correlation was found between pain perception and knowledge, or pain perception and diet diversity (r=0.062, p=0.534). However, a significant weak negative correlation (r=-0.289, p<0.05) between pain perception and attitude was observed. Patients undergoing fixed orthodontic treatment presented with overall low pain perception, a positive attitude, and good knowledge about their treatment with moderate diet diversity. Informing the patient in advance about different orthodontic procedures encourages a positive attitude and facilitates patient cooperation. An interprofessional approach involving nutritionists can provide a holistic patient approach during orthodontic treatment.

A spectrophotometric analysis of copper and zinc released from stainless steel brackets coated with a combination of copper oxide and zinc oxide nanoparticles in artificial saliva

Nanocoating stainless steel orthodontic brackets with a combination of copper and zinc oxide nanoparticles might alter the quantity of ions released from them in saliva. The purpose of the study was to evaluate the quantity of copper and zinc ions released from stainless steel brackets coated with a combination of copper oxide and zinc oxide. Stainless steel orthodontic brackets (Ormco Mini -Diamond series 0.22” slot, MBT prescription) (ORMCO CORP Glendora, California, USA) (n= 15 in each group) were coated with nanoparticles of copper oxide (Group I) , zinc oxide (Group II) and a combination of copper oxide –zinc oxide (Group III) nanoparticles using a spray pyrolysis method . The quantity of copper and zinc ions released from these three groups of brackets, when stored in artificial saliva and intubated at 37 C was evaluated at 24hrs, 7th day, 14th day and 28th day using an atomic absorption spectrometer. The three groups of coated brackets released significantly more copper and zinc ions than the uncoated brackets. The copper oxide nanocoated and zinc oxide nano coated stainless steel orthodontic brackets released more copper and zinc ions when compared to the copper oxide - zinc oxide combination nanocoated orthodontic brackets and uncoated brackets. The highest surge of ion release was noted at the 7th day in all the three coated groups for both the ions evaluated. Brackets coated with a combination of copper oxide and zinc oxide nanoparticles demonstrated reduced levels of copper and zinc ion release in artificial saliva when compared to copper oxide nanocoated brackets and zinc oxide nanocoated brackets..

A Stereo-Microscopic Study: In-Built Torque Comparison using MBT Prescription Brackets of Different Companies

Torsion in an "archwire" that forms a pair when it interacts with a "bracket slot" produces torque. The archwire moves the tooth through the torsional tension created in the activated state, depending on the degree of torsion, the size and quality of the wire, and the deformability of the bracket. The dimensions of the bracket hole may unintentionally vary when brackets are made. Therefore, the purpose of this study was to evaluate the accuracy of built-in torque from various manufacturers.  Objective:- To measure and analyse the built-in torque of the maxillary right canine brackets, maxillary right lateral canines, and maxillary right central incisors from commercially available bracket systems (JJ Orthodontics, American Orthodontics, Koden Orthodontics, Desires - Ozone series). The brackets will be measured in 0.022 inches.  Material and Method:- The sample was made up of three brackets from each company (maxillary central incisor, lateral incisor, and canine), the torque of which was measured in a dimension of 0.022 inches. Using a stereomicroscope, images were captured, measurements were made following operator calibration with IMAGE PROPLUS, and a digital readout was generated.  Results:- In practically every bracket, the built-in torque mean values were lower. The built-in torque levels were most similar to the American Orthodontics standard values.

Case Study: Facemask Protocol for Growing Patient

This case report describes the orthodontic treatment of a 9-year-old Egyptian male with a Class III incisor relationship and skeletal Class III base, characterized by a -3 mm reverse overjet, 70% reverse overbite, and masticatory difficulties. The patient exhibited full unit Class III molar relationship, unclassified canine relationship, lower and upper crowding, concave profile, acute nasolabial angle, and competent lips. Treatment involved two phases: Phase 1 utilized an orthopaedic appliance (facemask) with banded hyrax and posterior acrylic bite planes, while Phase 2 employed upper and lower fixed pre-adjusted edgewise appliances with MBT prescription and class III elastics. This comprehensive approach aimed to address the malocclusion effectively and achieve improved dental alignment and facial aesthetics.

Evaluation of cytotoxicity of copper oxide and zinc oxide hybrid nanocoated orthodontic brackets

Using a combination of two nanoparticles for coating stainless orthodontic brackets might alter their potential cytotoxicity. The study investigated the cytotoxicity of brackets nanocoated with copper oxide, zinc oxide and a combination of both the particles. Stainless steel orthodontic brackets (Ormco Mini -Diamond series 0.22” slot, MBT prescription) (ORMCO CORP Glendora, California, USA) (n= 31 in each group) were coated with nanoparticles of copper oxide, zinc oxide and a combination of copper oxide –zinc oxide using a spray pyrolysis method. The brackets was assessed for cytotoxicity in mouse fibroblast (L929) using MTT assay with a standard control and a group of uncoated brackets for comparison. The optical density and percentage of cell viability of the 5 groups were compared with ANOVA and Post hoc Tuckey HSD. P value ≤ 0.05 was considered as statistically significant. The three groups of coated brackets and the uncoated brackets exhibited significantly lesser percentage of cell viability than the control group. The percentage of cell viability in all the four groups was greater than 70% Zinc oxide and copper oxide nanocoated brackets exhibited lesser cell viability than the combination group and the uncoated brackets.Brackets coated with combination of copper oxide and zinc oxide nanoparticles exhibited lesser cytotoxicity than the brackets coated with copper oxide or zinc oxide nanoparticles.

Dento-maxillary disharmony class I malocclusion with severe crowding, crooked canine, midline shifting and lip incompetence management: A case report

Objective: This case report aimed to provide treatment sequential DDM to meet the patient’s expectations. Case Report: Before starting the treatment, 2 first upper premolar needed to be extracted to gain space for severe anterior crowding teeth and 2 second lower molar because the teeth were not in good condition. After extraction, bracket placement with fixed appliance 0,22” MBT prescription and NiTi wires sequences were done for initial leveling. When it has already leveled, start for canine retraction using an elastomeric chain in wire SS 0,016x0,022-inch. Then, T-loop bends were used for anterior retraction in the same wire. Finishing detailing using SS 0,017x0,025-inch. The last one, Hawley Retainer, was used as a retainer. Results: The final results were as expected by the patient. She gained confidence through her new smile, and the orthodontist obtained what it needed for ideal occlusion except for Class I molar relationship because mesialization of the second lower mandibular tooth, and distalization of the anterior mandibular region but Class I canine were obtained, no rotation, no space, flat occlusal plane, and excellent crown angulation and inclination. Also, the patient’s lip became competent. Conclusion: This case concludes that the patient was happy with the overall treatment results and was satisfied with the pleasant and esthetic smile achieved at the end of the treatment.

Treatment of Vertical Maxillary Excess in Skeletal Class II Hyperdivergent Face Using Skeletal Anchorage—An IBO Case Report

This case report was presented at the Indian Board of Orthodontics (IBO) examination under category III in September 2022. It describes the case of 13-year-old female with hyperdivergent facial pattern and class II skeletal base, treated using microimplant anchorage. Patient presented with vertical maxillary excess, increased lower facial height, gummy smile, and incompetent lips. All four first premolar extraction treatments were planned with simultaneous retraction and intrusion of maxillary and mandibular dentition. The case was treated using 022 slot MBT prescription appliance. Lip exercises were prescribed to increase the tone of lips, which would aid in attainment of lip seal. Case was completed with class I molars, normal overjet–overbite, and improved smile aesthetics. The patient exhibited competent lips and reduced anterior–posterior gingival show.

Salivary and crevicular fluid proinflammatory cytokines and advanced glycation end products in patients with different glycemic levels undergoing fixed orthodontic treatment.

To examine whether patients with different blood glycemic levels undergoing fixed orthodontic therapy demonstrate changes in the biochemical profiles of crevicular fluid and salivary advanced glycation end products (AGEs) and proinflammatory cytokine levels in comparison with nondiabetic healthy subjects. Prediabetic subjects, subjects with type 2 diabetes mellitus (T2DM), and subjects without a diabetes mellitus diagnosis undergoing fixed orthodontic therapy with MBT prescription brackets (0.022-inch brackets and 0.019 × 0.025-inch stainless steel archwires) were included in the study. The following clinical periodontal parameters were evaluated: (1) plaque score (PS), (2) probing depth (PD), (3) bleeding on probing (BOP), and (4) clinical attachment loss. Crevicular fluid and saliva specimens were collected during regular orthodontic visits. Salivary and crevicular fluid tumor necrosis factor alpha, interleukin-6, ghrelin, resistin, AGEs, and receptor activator of nuclear factor κΒ ligand were evaluated using a human magnetic Luminex multiplex assay. BOP scores were significantly higher among T2DM subjects (19.2%) than among nondiabetic subjects (11.2%) and prediabetic subjects (15.9%). Comparable values were demonstrated by all three study groups regarding PD scores and PSs. T2DM subjects demonstrated higher scores for gingival crevicular fluid (GCF) chemokines than nondiabetic and prediabetic subjects. A statistically significant difference was found in the levels of AGEs and resistin among the three study groups. The scores revealed for the levels of GCF resistin and AGEs versus periodontal BOP demonstrated a significant positive association by the Pearson correlation test. T2DM patients demonstrated significantly higher levels of GCF resistin and AGEs during fixed orthodontic therapy. Chronic hyperglycemic patients undergoing orthodontic therapy demonstrated a proinflammatory response.

Tongue Adaptation and Airway Changes in Two Different Bracket Systems: A Randomised Clinical Trial

Introduction: Orthodontics apart from correcting the malocclusions provide an invariably indirect effects on surrounding musculature and airway by means of creating room for proper tongue posture which helps in improvement of oropharyngeal airway dimensions along with dentoalveolar corrections which in this study was experimented with two different bracket systemsMBT and Damon self-ligating systems. Aim: To assess the adaptation of tongue and oropharyngeal airway changes following treatment with two different bracket systems. Materials and Methods: This randomised clinical trial was conducted in the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, and included 20 participants and categorised into two groups: Group 1 and group 2 included participants who underwent orthodontic treatment with Damon appliance therapy with Damon Copper NiTi (CuNiTi) wires and MBT prescription with Damon CuNiTi wires. Lateral cephalogram and intraoral scanning was done at the start of orthodontic treatment (T0) and after one year (T1). Cephalometric and occlusal model assessment to determine the adaptation of tongue and Oropharyngeal Dimensions (OD) were determined (T0-T1) using the Facad® and 3-shape software. Independent t-tests and paired t-tests were done to compare T0 and T1 for both the groups were done using Statistical Package for the Social Sciences (SPSS) software. Results: Results of paired t-tests showed a statistically significant difference at the Interpremolar distance (IPM1) region of both groups 1 and 2 between T0 and T1 (p=0.034, p=0.011), Intercanine distance (IC) of group 2 upper (p=0.043) and IPM2 of both the groups in the upper arch (p=0.042, p=0.022). Cephalometric results showed a significant increase in all the assessed parameters within the groups between T0 and T1 (p&lt;0.05). Oropharyngeal space did not show any difference in both the systems however comparatively increased in group 1 than in group 2. Conclusion: Treatment with Damon and MBT prescriptions with Damon Cuniti wires showed significant alterations in adaptation of tongue and oropharyngeal space and also in bringing about arch expansion in maxilla and mandible with the greatest expansion noted for first premolar of both the groups and IC and Interpremolar (2nd premolar) width of the upper arch of both the groups.

Evaluation of effects of Forsus Fatigue Resistance device in correction of class II division 1 malocclusion in adolescent patient: A case report

Introduction: Class II malocclusion is one of the most prevalent malocclusions. The Class II malocclusions are caused due to forwardly placed maxilla, the backward position of the mandible, or a combination of both these factors. This disparity in skeletal base growth and position can be corrected during growth spurts using functional and fixed functional appliances. Description: An adolescent boy with Class II division 1 malocclusion, retrusive mandible, and increased overjet was treated with a pre-adjusted edgewise appliance (0.022-slot Gemini 3M -MBT prescription) along with a fixed functional appliance, Forsus TM Fatigue Resistant Device. The Skeletal age of the patient assessment using Hand wrist radiograph and CVM showed a major part of the adolescent growth spurt to be completed. Pre-treatment and post-functional cephalograms were traced and superimposed to compare changes in the skeletal base and dental structures. Result: The Class II molar and canine relationships were corrected to class I and the mandible showed forward positioning leading to correction for the skeletal base to class I. The facial profile showed marked improvement to an orthognathic pleasing profile. Conclusion: The purpose of this case report is to emphasize on use of fixed functional appliances in the treatment of adolescents with skeletal base discrepancies like Class II division 1 malocclusion. Intervention with fixed functional appliances at the appropriate skeletal age can prevent the need for extractions or other surgical procedures that may be needed to correct the malocclusion.

Management of a Skeletal Class II Malocclusion: An Indian Board of Orthodontics Case Report

This case report submitted as a Category II case report in the Indian Board of Orthodontics Phase III exam describes the orthodontic treatment of an 11-year-old female patient with a skeletal Class II malocclusion due to mandibular retrognathia. She presented in the late mixed dentition and was treated with a two-phase treatment protocol. The first phase involved growth modulation with a Twin Block Appliance for mandibular advancement followed by the second phase of treatment with upper and lower fixed appliances and a non-extraction treatment plan. The fixed appliance used was 0.022’’ slot, metal pre-adjusted edgewise appliance with MBT prescription. The summary of the treatment, the case report, and the various records are reprinted here with minimal editing and reformatting so that the presentation resembles the actual documents submitted to the board.

Comparison Of Shear Bond Strength And Adhesive Remnant Index Between Different Adhesive Systems In Bonding and Rebonding of Orthodontic Brackets

Aim: The aim of this study was to compare the shear bond strength (SBS) and adhesive remnant index of stainless-steel brackets bonded with different orthodontic adhesive systems. Materials and Methods: In our study performed on 60 premolar teeth extracted for orthodontic reasons, MBT prescription 0.022'' stainless-steel brackets (Discovery Smart®, Dentaurum, Germany) were used. In teeth randomly divided into 3 groups, bonding was performed with Group 1: Trulock Light Activated Bonding System (RMO, USA), Group 2: Bisco Ortho Bracket Paste LC (Bisco, USA), Group 3: Transbond XT Light Cure Adhesive (3M, USA). SBS and residual adhesive indexes (ARI) were evaluated by breaking the samples. Adhesive residues were cleaned with tungsten carbide burs from the surfaces of the teeth, rebonding was made after sanding the brackets’ surfaces. SBS and ARI values were re-evaluated. One-way ANOVA, two-sample t-test and Mann-Whitney U tests were used for statistical analysis of the data, p &amp;lt;0.05 was considered statistically significant. Results: Statistically significant differences were observed between Group 1 and Group 2 in comparison to the first SBS values of three different orthodontic adhesive systems to enamel (p &amp;lt;0.05). Among the adhesive systems, only a statistically significant difference was found between the first bonding values and the rebonding values of Group 2 (p &amp;lt;0.05). There was no statistically significant difference between the first and rebond strengths of the other two adhesive systems. Rebonding values of three different orthodontic adhesive systems were very close to each other. Conclusions: The results of this study suggest that the adhesive systems developed for the bonding of orthodontic brackets to the enamel can show clinically enough bond strength even if the rebonding strengths of the falling stainless-steel brackets to the same enamel surfaces decrease slightly.

ORTHODONTIC EXTRUSION OF A SUB-GINGIVALLY FRACTURED INCISOR TOOTH– A MULTIDISCIPLINARY APPROACH

This case report details the multidisciplinary treatment approach of restoring a sub-gingivally fractured maxillary left central incisor of a 12-yr old boy. Orthodontic extrusion, tooth exposure with electrocautery, endodontic treatment and composite direct veneer was planned after careful examination and diagnosis. After taking preliminary records, maxillary arch was bonded with pre-adjusted xed orthodontic appliance (022 slot MBT prescription) and 0.018” AJ Wilcock wire was indirectly ligated to the lingual button bonded on the fractured tooth. Approximately 3 mm of orthodontic extrusion was achieved in three months' time with orthodontic extrusive mechanics and the fracture line was brought above the supragingival level. The fractured tooth was then taken up for aesthetic rehabilitation. This multidisciplinary approach helped in saving front tooth of a young boy, preserved the supporting alveolar bone, limited the involvement of adjacent teeth and improved quality of life of this child. Six months follow up after treatment revealed good periodontal health, aesthetics and normal function.

Comparison of shear bond strength of orthodontic metal brackets recylced using different methods: An in-vitro study

The aim of this study was to compare the effect of recycling orthodontic metal brackets by sandblasting with aluminum oxide particles of different sizes and by laser blow method after first and second rebonding /recycling. 120 human premolars extracted for orthodontic purpose were randomly divided into four groups. 40 MBT prescription Orthodontic metallic brackets were bonded on the buccal surface of the samples. Brackets were recycled by sandblasting with 3 different particles size and laser. Debonding of all brackets was performed using a universal testing machine and shear bond strength was determined. Brackets were examined under Field emission scanning electron microscope from each group at each level to compare the surface characteristic of new and rebonded brackets. Data were analyzed with paired test, ANOVA, and post hoc tests.The shear bond strength of group I (sandblasted with 25µm alumina) was significantly higher at the end of 1st recycling compared to group II(50 µm) and III(100 µm) but it was comparable to group IV(laser) at the end of 1st recycling. Group IV showed clinically significant higher shear bond strength compared to group II and III after 1st and 2nd recycling. The shear bond strength for group II and III (sandblasted with 50 and 110µm alumina) was significantly much lower after 2nd recycling as compared to new i.e., Control (p value&amp;#60;0.001⁎⁎⁎).25µm alumina sandblasting and Er-YAG laser blow method obtained better results after three successive recycling. Overall sandblasting emerged as the best method to recycle the orthodontic brackets.

Cephalometric Evaluation of Changes in Tongue Position, Posture and Pharyngeal Airway Dimensions Following Treatment of Angle’s Class 1 Bimaxillary Proclination

Objectives:The aim of the study is to determine and correlate the effects of anterior teeth retraction on tongue position, posture and pharyngeal airway dimensions, in Angle’s Class 1 bimaxillary dentoalveolar proclination cases treated with all first premolar extraction. Materials and Methods:Pre and post treatment lateral cephalogram of fifteen Class I bimaxillary dentoalveolar proclination patients in the age group of 15-25years treated orthodontically as maximum anchorage cases with Preadjusted Edgewise Appliances (MBT prescription) and extraction of all first premolars were compared. Results:Tongue position analysis showed significant decrease in tg1: 2.2 +/- 1.52 mm (p = 0.001) and TGL: 4.2 +/- 3.877 mm (p = 0.001). Tongue posture analysis showed a significant decrease in Point 1: 1.48 +/- 1.92 mm (p=0.028), Point 2: 1.44 +/- 1.46 mm (p=0.008) and Point 5: 1.92 +/- 2.45 mm (p=0.026).Pharyngeal airway analysis showed significant increase in PNS-Ad1: 1.2 +/- 1.69 mm (p=0.016) while V-LPW: 2.0 +/- 3.047 mm (p=0.023) was decreased. No significant correlation was found between changes in total tongue length and velopharyngeal and glossopharyngeal airway. Conclusions:A significant reduction in the total tongue length particularly in the posterior region was observed after retraction. Also there was a reduction in the distance between root of the tongue and uvula, dorsum of the tongue and the roof of mouth in the posterior and anterior part of palate respectively. There was an increase in the lower nasopharyngeal airway and a decrease in the hypopharyngeal airway.

Autotransplantation for the correction of unfavorably impacted canines

The canine is diagnosed as impacted when its normal eruption time is significantly exceeded compared to the contralateral canine or the premolars. This case report presents, a female patient 14 years old with bilaterally impacted maxillary canines, retained maxillary deciduous canines, and proclination and spacing of the upper and lower anteriors and peg laterals. The treatment objective was to create a more ideal overjet and overbite relationship, place the impacted canines into position, and improve facial profile. Fixed orthodontic treatment was done with PEA “0.022 × 0.028” ORMCO, MBT prescription. After leveling, aligning, and space closure, extraction of bilaterally retained deciduous canines and autotransplantation of the unfavorably impacted canines were done. To enhance esthetics, composite restoration was done on the peg laterals. The total treatment time was 2 ½ years and the treatment objectives were achieved due to excellent patient cooperation. Facial harmony was good, and proclination and spacing were corrected.

Non-extraction orthodontic treatment in a patient with severe anterior crowding

A 12 years 6 months old Indian male presented with a chief complaint of irregular upper and lower front teeth. Patient exhibited a mild convex profile on Class l skeletal base with slightly decreased vertical proportions. This was complicated by severe upper and lower labial segment crowding. Also the molar relationship was half unit class ll bilaterally. Since the patient did not want to go for extraction of premolars, treatment involved use of Pendulum appliance along with upper and lower pre-adjusted edgewise appliance (0.022x0.028” slot) with MBT prescription. Various elastics and overlay wires were used along with proximal stripping for the correction of severe crowding in upper and lower anterior teeth.: Clinically Angle’s Class I occlusion was achieved bilaterally with good intercuspal relationship. Vertical growth continued throughout the treatment.