Treatment and management of impacted canine with speed appliance

Palatally displaced canine
Labially impacted canine
Mandibular impacted canine

slideshare.net/sylvainchamberland

Side effect of straight wire
mechanics in the 2 nd order

• Detrimental side effect
! Intrusion and tipping of the canine and premolar
toward the canine space
! Cant of the occlusal plane

• Tx objective of canine extrusion
! To avoid side effects

Sem. Ortho. 1: p24, 2001 & 3: p156, 2001

©Dr Sylvain Chamberland

Da.Le.0309 Da.Le.0710

•Mx: 3 segments
•016 Supercable in the auxilliary slot
•Patient was instructed to wear !
elastic 3/3-4
•He didn’t...
•Mx: 19x25 TMA, 17-22
•016 Supercable in the auxilliary slot
•Patient was instructed to wear ! elastic 3/3-4
Da.Le.0710

Da.Le.150710
Da.Le.181010

•After 6 weeks
•Occlusal plane is leveled
•Box loop will continue uprigthing of #13

Da.Le.300811

Patient went to Afghanistan 10 months

August, 10 October, 10 August, 11

Selective approach to canine
eruption
• Main rigid archwire

• Flexible overlay auxiliary wire

• SPEED bracket
! Auxiliary slot and arch wire

Sem. Ortho. 1: p24, 2001


OOPS!
• .016 supercable / .016 CNT •.016 CNT / .016 X .022 CNT

May 14

June 25


Segmented approach to canine
eruption

• Main rigid archwire
! To prevent mesial molar tipping

• Cantilever spring
! Anterior extrusion, posterior intrusion

! Counterclockwise moment at the molar


Segmented approach to canine
eruption

• RPE and coil to open the space for the canine
• Cantilever for canine extrusion

• No intrusive side effect in the anterior region

Segmented approach
• Cantilever on a
removable appliance
! Excellent anchorage
Fr.Tr.121107
15 w
Fr.Tr.121107
26 w
! Very few, if any, side effects

Fr.Tr.250208 Fr.Tr.120508


Flexible overlay wire

• Mx: .020 x .020 HA NiTi
! Auxiliary .016SC

Ma.La.19-03-09

F.O.W.:15 weeks

Ma.La.19-03-09 Ma.La. 30-06-09

+7w

Ma.La. 30-06-09 Ma.La. 17-08-09

Ma.La. 17-08-09 Ma.La. 29-09-09

Detrimental side effect in 2nd order
• High #23

• Cl II elastic to enhance
Al.Du. 15-05-09
extrusion + distallization Al.Du. 05-08-09

of 23 + protraction of 36

• But
! Forces & moments move
teeth


Canine impaction
• Sentalloy coil spring to open space.

• Main arch: .019 X .025 CNT.

• Auxiliary wire: .016 CNT.


Canine impaction
• TPA .032 X .032 TMA + mesial
out on #18 and #26.

• Elastomeric chain from molar
hook to 2nd premolar.

• Coil spring to open space.


Transpose #23
• Baliste cantilever
! .017 NiTi spring

Ce.Che. 07-04-09

Ce.Che. 12-01-09

Could be used with PDC

Cantilever Arm

Che.Ce 070409

Che.Ce 210509

Cé.Ch. 21-05-09 • Anchorage loss
! Should have been
anticipated
! Poor collaboration
with elastic wear did
not help
Cé. Ch.16-06-09


• Tooth #22 was not
engaged since last 6
weeks

• Transposition is
corrected
Cé. Ch.15-09-09
Cé. Ch.16-06-09


Cé. Ch.05-11-07
Cé. Ch.24-08-11, 9 months into retention Cé. Ch.20-01-11, 2 months into retention

• Lack of septal bone
between 22-23 need to
be monitored

• Root resorption is noted



Ch.St-P. 0408

• Full thickness palatal ﬂap

• Create opening through palatal
mucosa

• At 4 months
! Main arch: .020 x .020 HA niti Ch.St-P. 27-06-08

! auxiliary wire: .016 HA niti

• Ligatures are retighten

! Bonded button #23 buccal
Ch.St-P. 06-10-08

• Canine bonded at 35 weeks

! auxiliary .016SC engaged

• At 11 months

! Canines are rebonded

Ch.St-P. 08-04-09


Ph.St-Pi. 08-04-09

• Transmucosa exposition «à la Kokich» Ph.St-Pi. 22-09-09

• Removable appliance & ﬁnger spring
cantilever

Ph.St-Pi. 22-09-09


• Sequence

! September: Engagement

Ph.St-Pi. 22-09-09
! October:1st control
Ph.St-Pi. 20-10-09
! November: 2nd control

! December, at 13 weeks:
Bond 13 & 23

! February, at 19 weeks

Ph.St-Pi. 03-02-10 Ph.St-Pi. 23-12-09


Fixed appliances only

Ch.St-P. 150408 Ch.St-P. 030211

144 weeks

Removable cantilever spring & ﬁxed appliances

Ph.St-P. 080409 Ph.St-P. 310811

120 weeks

Surgical approach
Full thickness ﬂap
Ostectomy
Curettage of the dental
follicle

Opening window
through the mucosa
Flap closed + sutured
Ga.Vi. 120510


Ga.Vi. 120510
Sentalloy uprighting spring
02-000-01& 00
Sentalloy rotating spring
10-003-01;02; 03;04
Ga.Vi. 230610
Ga.Vi. 260510 At 6 weeks
At 2 weeks

Ga.Vi. 040810
Ga.Vi. 150910
At 12 weeks
At 18 weeks

Ga.Vi. 120510
02-000-01& 00
10-003-01;02; 03;04
Ga.Vi. 150910 Ga.Vi.261010
At 18 weeks At 24 weeks

•Bond #13
".016 SC™ aux. wire.

Ga.Vi.151210 Ga.Vi.020211 Ga.Vi.230211
At 31 weeks
©Dr Sylvain Chamberland At 38 weeks At 41 weeks

Ga.Vi. 120510
02-000-01& 00
Ga.Vi.230211 10-003-01;02; 03;04

At 41 weeks

• Rebond 13; .016 sent. aux. wire

Ga.Vi.060411
At 47 weeks post ligation

Ga.Vi.060411
At 47 weeks post ligation

• Rebond #13; .016 sent.; #13 is engaged

Ga.Vi.180511
At 53 weeks post ligation; 75 weeks into treatment

Remarks

• Pulling an impacted canine with ﬁxed appliance, ﬁnger
spring or auxilliray wire is a good and predictable
approach

• However, using a removable appliance with SS cantilever
spring may be faster to bring the canine at the level of the
mucosa


Remarks

• For more details about surgical exposure go to

• http://www.slideshare.net/sylvainchamberland/2-0-
ruptions-ectopiques-approche-chirurgicale

• 2 0 Éruptions ectopiques_Management chirurgical des
canines incluses


Ma-Ch.Po010910
Canine ligated at 41
weeks

Ma-Ch.Po061010 Ma-Ch.Po120111

• Can you explain why the canine is
rotated? Evolution of the
Evolution at 19
• In which direction? canine in 5 weeks
• Why the force couple is done this weeks post ligation
way at 19 weeks? post ligation

Ma-Ch.Po060411
Ma-Ch.Po240811

Ma-Ch.Po120111

31 weeks post 51 weeks post
Evolution at 19
ligation ligation
weeks post ligation
72 weeks into tx 92 weeks into tx

92 weeks
• Extraction: x, x, x, x X X
X X
• Surgical exposure of 13
X
was delayed X

• Ligation could have been
done from start and
traction initiated with a
removable appliance and
cantilever spring


Ma-Ch.Po291009

92 weeks into tx
• Finishing bends
Initial
June 2010

Ma-Ch.Po240811


Impacted Lower Canine
• What is your diagnosis?
! ...

• Full thickness ﬂap.
Ch.Tr0610
Should have been ligate
Ch.Tr260810
enough apically to
expose the crown
9 weeks
! #33 engaged

Ch.Tr071010
• Healing at 7 weeks Ch.Tr251010

! Finger spring initiated 13 weeks
I let the ginviva heal for 3 months.
The keratinized gingival bridge has gone
A bracket was bonded in late march
©Dr Sylvain Chamberland 2011
Ch.Tr231110

Impacted Lower Canine
• I apologies.

• The outcome, despite 9 weeks
nice eruption of the
canine, is the worse case Ch.Tr251010
Ch.Tr260810 scenario in term of
keratinized attached
gingiva 13 weeks

• A keratinized tissue Ch.Tr231110

graft is necessary

Ch.Tr040411

Impacted canine
• Vestibular position
• #12 & 22: displaced labially and distally
• High vestibular bulge #23
• Labial vestibular bulge #33

Fr. Tr 02-06

• #13 buccal to # 12

• #23 horizontal

• #33 mesially tipped Fr. Tr 02-06


• Extraction of 53, 63, 73, 83
Fr. Tr 02-06

Fr. Tr 09-06


Fr. Tr 02-06 Fr. Tr 09-06 Fr. Tr 03-07

• Extraction of 54, 64, 74, 84

• Favorable auto correction
of 13 & 33

•
Fr. Tr 10-07

23 still horizontal


• Tx:

! Ligature of 13, 23, 33

! Traction with removable appliance

Fr. Tr 10-07


• Closed eruption technique

• Traction with elastics & Hawley

Fr. Tr 11-07

Fr. Tr 10-07

• #13

Fr. Tr 01-08


Fr. Tr 02-08


Fr. Tr 04-08

Fr. Tr 05-08

• Ready for braces
3rd order discrepancy
! Tx initiated july-08

Fr. Tr 06-08


• Mx: .016 supercable

• Md: .019 x .025 HA niti

Fr. Tr 15-09-08


• Mx: .018 supercable

• Md: .020 x .020 HA niti

Fr. Tr 09-12-08


• Mx: .020 x.020 HA niti

! To initiate torque correction 12 & 22

• Md: .020 x.020 HA niti

Fr. Tr. 03-02-09


• Mx: .020 x .025 Niti Speed wire

• Note 3rd order problem to be
corrected

Fr.Tr. 19-03-09


• Rebond #12 with special torque

• .020 x .025 niti SW

Fr.Tr.11-05-09


• Reassessment of bracket
position Fr.Tr.17-08-09

• Pr: exo #75 & #85


• May 09 to Feb 10

• Torque of 12 and 22
has improved with
Fr.Tr.11-05-09
full dimensional 20 x Fr.Tr.09-02-10

25 SW

• Delayed eruption of
lower 2nd premolar
extrend the
treatment time


• Open eruption technique
! Full thickness palatal flap

" Bonded button on canines

A-A Gag 1104
" Closing + suturing the flap

" Create opening through the flap

A-A Gag 0505


A-A Gag 0505 A-A Gag 0605 A-A Gag 0805

A-A Gag 1105 A-A Gag 1106

A-A Gag 0805

A-A Gag 1105

A-A Gag 1105



Ca-A.Bo.04-05

• Age: 20 y

• Extraction 53, 63

• Closed eruption approach


Ca-A.Bo.08-07 Ca-A.Bo.10-07

• Bonded button + elastomeric chain

• Correction of rotations 13 & 23

Ca-A.Bo.04-08
©Dr Ca-A.Bo.11-07
Sylvain Chamberland Ca-A.Bo.01-08

Ca-A.Bo.08-07

Ca-A.Bo.10-07

Ca-A.Bo.11-07


Ca-A.Bo.11-07

Ca-A.Bo.01-08

Ca-A.Bo.04-08

Ca-A.Bo.04-05

• Tx duration: 32 months

Ca-A.Bo.11-08 Ca-A.Bo.08-10 21 months into retention

Transposed 23-22

Au.De. 17-11-08 Au.De. 12-01-09


Au.De. 12-01-09

• Severe ALD


Au.De. 30-06-09. •md: .016 sent med

• #23 was pulled distally from the removable appliance

• Removable appliance provide a good anchorage

• Root movement of the lateral incisor by ﬁxed appliances
is avoided

Au.De. 11-08-09. •md: .016 x.022 neost


Au.De. 30-06-09. •md: .016 sent med

Au.De. 11-08-09. •md: .016 x.022 neost

Au.De. 22-09-09.


Au.De. 17-11-08

• 8 months into treatment
Au.De. 05-10-09.

• From now: treatment is easy

Au.De. 05-10-09. Mx: .016 SC

Au.De. 19-12-06

Au.De. 23-02-09

• Easy, but it tooks times to get it done! 129 weeks

Au.De. 15-08-11


2006

Au.De. 17-11-08

2008

• She's happy!

Au.De. 15-08-11

2011


Pa.Be. 15-08-08

• Classe I

• Impacted #13

• Severe ALD


• Retained #53

• Very heigh #13

• Impacted 8's

Pa.Be. 15-08-08


• Bimaxillary protrusion

• Tx plan
!


At 54 weeks
• #13 is erupting

• Side effects are noted
! Cant of occlusal plane

! Intrusion of 12, 11

• Brackets and wires don't move teeth
! Forces and moments does


Pa.Be. 24-02-10

• Forced eruption was stopped from sept 09 to
feb. 10

• Mx occlusal plane had to be leveled: 22 weeks

! Mx: .020 x .025 niti & .016 sent cantilever to
distalize and extrude #13


Mx: .020 x .025 niti

Md: .020 x .025 SS
Pa.Be. 24-02-10

Pa.Be. 26-05-10 Pa.Be. 07-07-10 Pa.Be. 01-09-10

• Cantilever was effective to distallize and erupt #13

• Elastic ! was used to promote extrusion of the canine


Mx: .016 sent

Pa.Be. 01-09-10 Md: .020 x .025 SS

• Lower premolar are protracted with EC

Mx: .020 x.020 neost

Pa.Be. 06-10-10 Md: .021 x .021 x .020 x38 mm HDGW

• Mx: .020 x .020 neost, EC 23-o-25-26-27

• Md: HDGW to protract molars; square anterior section including
premolars is recommended

Pa.Be. 06-04-11

• Mx: .021 x .025 TMA (6 weeks)

! Does it slide? No!

• Md: .021 x .025 SS from january 2011 to august 2011


Pa.Be. 22-08-11

• 154 weeks!!

• Retrospectively, I would use a removable appliance and a
cantilever spring to erupt #13.

• It would have save me detrimental side effects and weeks of Tx


• Fairly good root parallelism

Pa.Be. 22-08-11


• She's happy


• Next


Treatment and management of impacted canine with speed appliance

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Treatment and management of impacted canine with speed appliance

Ähnlich wie Treatment and management of impacted canine with speed appliance (11)

Mehr von Dr Sylvain Chamberland

Mehr von Dr Sylvain Chamberland (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Treatment and management of impacted canine with speed appliance