Orthotown June 2019 - 19

Thanks to everyone for their responses. I am worried about losing the lower D's before I can
accomplish much. If the lower D's are not usable, how would you change things? ■

zxzxzx
Member Since: 02/28/03
Post: 5 of 15

12/20/2016

I've done two of these within one year. Prior to that, zero in 35 years. A CBCT would be best
before you do anything. While you can clearly see from the ceph that the cuspid is labial, you don't
know how thin the labial cortex is on the rest of the anteriors. I'm a bit surprised that there is no
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. ■

tcscotese
Member Since: 11/17/08
Post: 6 of 15

12/20/2016

Add the lower 6s instead of D's. and utilize the 4s once they erupt. If you wait for L4s to
erupt, the impacted 3 could get worse. ■

justinudm
Member Since: 09/29/14
Post: 7 of 15

12/20/2016

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. ■

Dfrech
Member Since: 03/16/09
Post: 8 of 15

12/27/2016

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. ■

tom525
Member Since: 06/18/08
Post: 9 of 15

12/27/2016

Share your complex cases online!
This message board is a great example of how Townies can
get advice and share different techniques with their peers.
To see more cases like this or to share your own, visit
orthotown.com/messageboard.

orthotown.com \\ JUNE 2019

19


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Orthotown June 2019

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