Orthotown July/August 2019 - 18

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sign of it in the images. You shouldn't necessarily use an open-coil spring unless you know how
thin the labial cortex is, because you don't know if you can advance the incisors without creating
a bigger problem. I would prefer to be in braces when the LDs shed, so I could use the little bit
of space that may be available to make more room for the LL3 without using a coil spring. Take
your time; I went ultraslow when retracting to give the unbonded LL2 time to move lingually.
You have to be careful that the LL2 doesn't perforate the lingual gingiva and expose the root and,
just as someone suggested, inform the parents that there may need to be perio to graft LL3, and
possibly the lingual of LL2. Good luck-if anyone can do it, you can. ■
12/20/2016

Dfrech
Member Since: 03/16/09
Post: 8 of 16

Charles, thanks for posting this. I agree with the previous posts: I would use a lower lingual
arch with room for the LL2 to go lingual, and double tubes on the 6s to use a directional spring
à la Chris Chang's approach for impactions. This would give you more directional control. ■
12/27/2016

tom525
Member Since: 06/18/08
Post: 9 of 16

I think that sometimes the tissue will mature around an impacted canine, and you'll get
some attachment. Charles' original post was more horizontal, so getting started early is a good
idea. A compressed coil against the anterior teeth was the force that got the canine moving. ■

12/27/2016

fesdds
Member Since: 05/22/08
Post: 10 of 16

portwireworks
Member Since: 02/13/14
Post: 12 of 16

I have fi xed so many of these types of cases. I usually get an LLA with loop on the facial near
the LD or LDE area. Have it uncovered and pull distal with PT once a month until you start
to see it in the place where the 3 should be. Then just let it erupt. Sometimes continue to PT to
lingual bar of LLA. No known problems after many fi xed, other than an occasional tissue issue.
and most don't need that. ■

Had a very similar one that finished about 6 months ago. Very tough to torque the canine
and the lateral in the end; took so long to get the canine into place that I had to compromise
on the torque a little because of time and patient burnout constraints. Curious that you stated
that you were going to bring the canine in as the first phase. I agree that the Ds won't be of any
help. No doubt in my mind that by the time you get that canine in, you would be into Phase 2.
Thankfully, the rest of the occlusion isn't bad, but how would you explain timing and fees to the
patient? To me, this is easily a 30- to 36-month situation, especially judging from the development
of the second molars. Not convinced that jumping in at this time-especially without a scan
telling me I have to-is the answer. ■
12/29/2016

Will this case be resolved with an easy fix,
or with a complicated Phase II approach?
Check out the advice from Townies and follow this case as it develops. Search "Mand
Canine" at orthotown.com/messageboard and this will be among the top results.

JULY/AUGUST 2019 // orthotown.com

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Orthotown July/August 2019

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