Conservative Treatment of Bilateral Impacted Mandibular Canines Traction
Table 2
Three phases of the therapy for the case report.
Phase I: active traction
Phase II: osteogenic rest
Phase III: full fixed orthodontic appliances
Goal: Upright and traction of both impacted mandibular canines.
Goals: Relieve stress from the neighboring tissues.
Goal: Comprehensive orthodontic treatment.
Alignment and leveling: Metallic brackets ( slot) in the mandibular arch including the primary teeth present. CuNiTi arch-wire (1 month before surgical exposure).
Maintain permanent canines upright and parallel to primary canines.
Bonding full fixed orthodontic appliance: Include all permanent teeth. Metallic brackets ( slot).
Temporary rigid anchorage device: Lower lingual holding arch (SS, 1.1 mm) associated with interproximal occluso-buccal extensions (SS .028″) with hooks in the distal direction.
Removal of the temporary anchorage device.
Extraction of the lower primary canines and immediate retraction, leveling, and alignment of the permanent canines.
Surgical exposure: Incision, flap, osteotomy, removal of dental follicles, clearance of canine crown, bonding of attachments, and NiTi closed coil springs ( diameter and 13 mm long).
Segmented arch to maintain coil springs tied.
Arch-wire sequence: Lower: CuNiTi , NiTi SS SS . Australian .016 for anterior extrusion and finishing.
Activation: Each 6 weeks. Traction force: 100 g.
Monitor root development of permanent teeth.
Upper: CuNiTi , NiTi SS (with boot loop for incisor derotation), SS SS .
