Uprighting horizontally impacted third molars by super-elastic nickel-titanium wire in patients with an extracted first molar.

Protracting lower second molars and uprighting horizontally impacted third molars is a significant orthodontic challenge in patients who require the extraction of severely decayed first molars. Here, we describe the use of biomechanics to upright 90°-tilted lower third molars following second molar protraction. Herein, we introduce a technique for uprighting the lower third molars by (1) the placement of superelastic nickel titanium archwires, (2) bonding, and (3) repositioning of a buccal tube in a tilted position to compensate for the efficiency of Ni-Ti (nickel-titanium) wire. The treatment mechanics used for our two cases showed that even severely impacted third molars can be uprighted by routine continuous straight-wire techniques. This technique proved to be a simple, efficient and reliable treatment option for uprighting horizontally impacted third molars.

Prevalence, etiology, clinical features and management associated with impacted and transmigrated mandibular canines: a systematic review.

BACKGROUND: The occurrence of mandibular canine impaction and/ or transmigration is a rare clinical entity but diagnosis and treatment planning is of clinical significance. The associated etiological factors and the clinical guidelines for the management are still not clear. The aim of this systematic review was to summarize the available data to report the prevalence and identify the etiological factors, clinical features, and various treatment outcomes in patients with mandibular canine impaction and/or transmigration. METHODS: The review protocol was registered in PROSPERO (CRD42021222566) and was conducted and reported according to the PRISMA and Cochrane Handbook / Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A computerized search of studies published up to April 30, 2023, was conducted using the following databases: Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature. A manual search of the reference and citation lists of eligible articles and existing systematic reviews for any additions were also conducted. The Newcastle-Ottawa Scale quality assessment tool was used to assess the studies' quality. RESULTS: After removing 6 duplicates, 3700 articles were identified. For the final analysis, 19 studies published between 1985 and 2023 met all the eligibility criteria and were included. A total of 7 studies presented as good and 12 studies presented as satisfactory. Patients were screened in ten studies and diagnostic records from archives were retrieved in nine studies. The total number of diagnostic records screened was 138.394, and the total number of patients from the included studies was 43.127. CONCLUSIONS: Based on the findings from this systematic review, the prevalence of mandibular canine impaction ranged from 0.008% to 1.29% while canine transmigration from 0.12% to 0.98%. Crowding of the mandibular arch, the presence of a retained deciduous canine, and odontoma or cyst are the etiological factors more commonly associated with mandibular canine impaction and or transmigration. Surgical extraction and surgical exposure followed by orthodontic traction are the two most frequently carried out treatment modalities in the management of mandibular canine impaction and or transmigration.

Combined orthodontic-orthognathic management of a patient with generalized short root anomaly and anterior open bite.

Short root anomaly is a rare dental disorder affecting tooth root development. It is characterized by reduced root-to-crown ratios (1:1 or less) and rounded apices. The short roots introduce a potential complication during orthodontic treatment. This case report describes managing a girl with generalized short root anomaly, an open bite, impacted maxillary canines, and a bilateral crossbite. In the first phase of treatment, the maxillary canines were extracted, and the transverse discrepancy was corrected with a bone-borne transpalatal distractor. In the second phase of treatment, a mandibular lateral incisor was removed, fixed appliances were placed in the mandibular arch, and bimaxillary orthognathic surgery was performed. A satisfactory result was obtained without further root shortening, adequate smile esthetics, and 2.5-year posttreatment stability.

Maxillary Sinus Volume and Its Effect on Treated Impacted Canines.

The goal of study was to explore the role of 3D CBCT (cone beam computer tomography) in detecting impacted canines and their movement to evaluate the influence of orthodontic therapy parameters on treatment options, and to monitor quality of healing process based on shape and size of sinus maxillae volume. It is known that the volume of maxillary sinus plays an important role in patients with impacted teeth. The prospective study consisted of 26 individuals. For each individual, pre-treatment and post-treatment CBCT data were acquired. Changes of size, and position of impacted canine in 3D CBCT image before and after therapy were prepared using 3D reconstruction. Volumetric measurements of the maxillary sinuses were performed before and after orthodontic therapy of impacted canines, using InVivo6 software. The main effects MANOVA performed on linear measurements showed metric differences between pre-op and post-op images. A paired t-test showed no statistically significant differences between pre-op and post-op values of the sinus volume. Changes of size and position of impacted canine in 3D image before and after therapy were precise and reproducible, using 3D reconstruction in three planes - horizontal, midsagittal, and coronal. The linear measurements showed metric differences between pre-op and post-op images.

Retrospective evaluation of traction time for impacted dilacerated maxillary central incisors in mixed dentition.

PURPOSES: This study aimed to contribute to understanding the factors affecting the time of traction treatment of impacted dilacerated maxillary central incisors. METHODS: This retrospective study included children aged 8 - 11 years with a history of trauma, who applied to the pediatric dentistry clinics of Marmara University, School of Dentistry, between December 2013 and December 2019, and were treated for unilateral impacted dilacerated maxillary upper central incisors. Children's age, sex, digital panoramic radiographs, cone-beam computed tomography, and intraoral photographs were retrieved from electronic dental health records. The effects of children's age, sex, the direction of impacted teeth, distance of the teeth to the top of the alveolar crest, and root dilaceration level on traction time were analyzed by Mann-Whitney U test and Spearman's rank correlation coefficient test. RESULTS: The inverse position of the incisors significantly increased the traction time (P = 0.012). However, the traction time did not differ according to the sex of the children (P = 0.707) or the level of root dilaceration (P = 0.429). No correlation was observed between the traction time and the age of children (P = 0.644) or the distance of the incisors from the top of the alveolar crest (P = 0.397). CONCLUSIONS: In cases of the forced eruption of for the impacted dilacerated maxillary central incisors, the direction of the teeth should be evaluated when deciding on the treatment plan, as it may affect the treatment time.

Determination of the range of intervention timing for supernumerary teeth using the Korean health insurance review and assessment service database.

This study aimed to identify the frequency of complications during the diagnosis, observation, and treatment of supernumerary teeth or odontomas and evaluate the relationship between complications and the timing of surgical intervention. This study was conducted based on data from the Korea Health Insurance Review and Assessment Service between January 2008 and December 2019. A 2-year washout period was applied, and a follow-up period of at least 2 years was also included. During the observation period, the age at diagnosis of supernumerary teeth and odontomas was analyzed using major diagnostic codes, and the treatment codes were used to determine the interval between diagnosis and surgical intervention. The incidence rates of supernumerary teeth (1.21%) and odontomas (0.36%) were comparable to that reported in previous studies. The frequency of supernumerary teeth was the highest in the anterior region, followed by the premolar and molar regions. The average ages at diagnosis according to the location of the supernumerary teeth were 7.25, 13.98, and 16.11 years in the anterior, premolar, and molar regions, respectively. The age at diagnosis correlated with the maturity period of the teeth at the corresponding location. For the supernumerary tooth group, surgical intervention was more likely to occur when malocclusion (p < 0.0001) or tooth eruption disturbances (p < 0.0001) were present or dentigerous cysts were absent (p = 0.006). For the odontoma group, malocclusion (p = 0.251) was not correlated with surgical intervention. When tooth eruption disturbances (p = 0.002) and dentigerous cysts (p < 0.0001) were present, surgical intervention was more likely to occur. Pediatric dentists should conduct timely clinical checks and periodic follow-ups to prevent complications and unnecessary orthodontic treatments in patients with supernumerary teeth or odontomas.

A non-invasive system to manage impacted teeth associated with a large dentigerous cyst.

A male patient aged 11 years presented a large dentigerous cyst in the lower left quadrant associated with retained deciduous lower lateral incisor and canine and impacted, unerupted corresponding permanent ones. The treatment consisted in marsupialisation and placement of a modified lingual arch that held a tube for decompression used for irrigation of the cystic cavity in a comfortable way for the patient and for the clinician.The same lingual arch was later used as an anchorage method for traction of the retained teeth. The final records showed complete resolution of the cyst and retained teeth were successfully Aligned into the oral cavity.

Cone beam computed tomography indications for interdisciplinary therapy planning of impacted canines.

OBJECTIVE: To investigate how cone beam computed tomography (CBCT) affects the therapeutic planning of impacted maxillary canines. STUDY DESIGN: A total of 132 impacted canines from 89 pediatric patients were collected from 3 specialist clinics in Stockholm, Sweden. An interdisciplinary therapy planning team consisting of 5 dental specialists evaluated each case and chose their preferred treatment alternative, initially without and later with CBCT images, to decide whether CBCT was justified for therapy planning. Predefined variables measurable using only 2-dimensional (2D) assessments were analyzed using stepwise logistic regression analyses. RESULTS: The CBCT was considered indicated in 47% of the cases. Additional information from CBCT led to a treatment decision change in 9.8%. Significant 2D predictors for CBCT justification were horizontal canine angulation compared with vertical angulation (odds ratio [OR] = 10.9), extraction strategy involvement (OR = 6.7), and buccally positioned canines compared with palatal (OR = 5.3), central (OR = 25.0), and distal or uncertain positions (OR = 7.7). CONCLUSIONS: The benefit-risk assessment of CBCT for impacted canines may be reinforced by performing and applying justification decisions for CBCT acquisition at the therapeutic thinking level. If preliminary treatment planning motivates further in-depth investigation of either root status or tooth location, a CBCT is indicated.

The effect of the root dilaceration on the treatment duration and prognosis of unilateral impacted immature maxillary central incisors.

INTRODUCTION: This study aimed to investigate the effect of root dilaceration on the closed-eruption technique treatment and prognosis on impacted immature maxillary central incisors. METHODS: In this retrospective study, we compared the age at the beginning of the treatment, the treatment duration, root development, and alveolar bone mass after the closed-eruption technique between the impacted immature maxillary central incisors with dilacerated roots (group 1) and those with straight roots (group 2). RESULTS: The mean age at the time of the surgery of group 1 was 0.9 years younger than that of group 2 (P = 0.008). The mean traction time was greater in group 1 (8.0 ± 1.8 months), with a difference of 1.4 months than in group 2 (6.6 ± 2.1 months) (P = 0.042). The measurements of lingual bone thickness at the alveolar crest (C) showed significant differences between the 2 groups (P = 0.025). No significant differences were found in other treatment duration or measurements of root development and alveolar bone mass between the 2 groups. CONCLUSIONS: Patients with impacted immature incisors with dilacerated roots were younger at the beginning of the closed-eruption treatment and had a longer traction time than those with impacted immature incisors having straight roots. The root dilaceration had little or no effect on root development and alveolar bone mass after the closed-eruption treatment. The closed-eruption treatment of impacted immature incisors with root dilaceration is suggested to commence as early as possible.

Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial.

BACKGROUND: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla. METHODS: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment). DISCUSSION: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children. TRIAL REGISTRATION: ISRCTN Registry ISRCTN12709966 . Registered on 16 June 2022.

Three-Dimensional Leeds Orthodontic Root Resorption Target Scale (3D-LORTS): A new structured pictographic tool for reporting root resorption caused by impacted maxillary canines detected on CBCT images and its impact on orthodontic treatment planning.

OBJECTIVES: The objective of this study was to determine whether use of a root resorption pictogram, the Three-Dimensional Leeds Orthodontic Root Resorption Target Scale (3D-LORTS), in addition to cone beam computed tomography reports was associated with a change in orthodontic extraction decisions in cases with impacted maxillary canines and associated root resorption of adjacent teeth and to assess orthodontists' experiences using the pictogram. STUDY DESIGN: Orthodontists completed a web-based survey in which they selected their preferred treatment plan for 6 cases. Each case was randomly presented twice, initially without and then subsequently with the pictogram. Statistical analysis was conducted to assess differences in extraction decisions with and without the pictogram and the participants' experiences using the 3D-LORTS. RESULTS: A total of 194 orthodontists completed the survey. Significant differences in treatment decisions were found for 3 individual cases (P < .05) and for the 6 cases overall (P < .05). The majority of participants had positive perceptions of the pictogram, particularly with respect to ease of use, effect on understanding of root resorption location and severity, and usefulness as a communication aid. CONCLUSIONS: Inclusion of the pictogram in cone beam computed tomography reports was associated with an overall change in orthodontists' extraction decisions. The majority of orthodontists reported positive experiences using the 3D-LORTS.

Miniscrew-supported pole technique: Surgical-orthodontic approach for impacted or retained second molars in adolescents.

BACKGROUND: Several treatment options have been proposed for the treatment of eruption disturbances of permanent molars. Despite being an infrequent condition, these disturbances should be solved as they can lead to important complications and play a relevant role in completing the occlusion. FINDINGS: The presented cases involved maxillary and mandibular included second molars (M2s) respectively. Both teeth erupted successfully after the application of the miniscrew-supported pole technique, and a functional occlusion was established. CONCLUSIONS: This technique is a surgically assisted orthodontic procedure performed to force the eruption of impacted/retained M2s. This device uses one mesial miniscrew which allows the application of relevant force to achieve the eruption of complicated retained/impacted M2s within a short period of time.

Interception and early treatment with rapid maxillary expansion for the impacted maxillary permanent central incisor in children: Two cases report with 5-years follow-up.

INTRODUCTION: The maxillary central incisor impaction represents a complex challenge in paediatric dentistry practice and may result in aesthetic and functional disharmony. The causes of this condition include physical barriers associated or not with a lack of space making eruption not possible, idiopathic ectopic positioning of the teeth or by trauma, non-coordination in rhizalysis and rhizogenesis between deciduous and successor or tooth shape abnormalities. The incidence of this involvement is quite rare, around 1% of the population. Opening of space through disjunction of the palatal suture is the main treatment proposed to solve this situation and, when necessary, the orthodontic traction assisted by surgery. DESCRIPTION: Were presented two cases of maxillary central incisors impaction in children treated with rapid maxillary expansion, alignment and levelling, and a follow-up after 5 years of treatment. RESULTS AND CONCLUSIONS: The challenge of these treatments were based on the early treatment in mixed dentition with expansion. The treatment of permanent maxillary central incisor impaction in children enabled excellent periodontal response and post-treatment occlusal stability.

Retenciones múltiples. Reporte de un caso / Multiple retention. Case report

RESUMEN La retención dentaria es común encontrarla en la clínica de ortodoncia, los caninos maxilares son los de mayor solicitud de tratamiento por su importancia estética. Sin embargo, no es frecuente la retención de dientes temporales. Su etiología no está bien definida pero se considera de carácter multifactorial. Se presentó una paciente del sexo femenino de 12 años y medio de edad, con ausencia de 15 y 13, presencia de 53 y mesogresión del 16. Al examen radiográfico se observó retención de 55, 15 y 13, este último en transposición incompleta con el 12. Después de un profundo análisis se decidió exéresis del 55 y alineación al arco dentario de 15 y 13, mediante colocación de un dispositivo, con el empleo del sistema de cementado directo en el acto quirúrgico. Se estableció una oclusión funcional y estética aceptable, con particular cuidado de la integridad de los dientes vecinos y sus tejidos blandos. Las retenciones constituyen maloclusiones dentarias complejas y de difícil pronóstico y tratamiento, más aún cuando son múltiples. Se requiere de estudio y tratamiento multidisciplinario (AU).

ABSTRACT It is common to find teeth retention in Orthodontics clinic; maxillary canines, due to their esthetical importance, are the ones the patients ask to be treated more frequently. Nevertheless, temporary teeth retention is not frequent. Its etiology is not clear, but it is considered multifactorial. The authors present the case of a female patient, aged 12 years and a half, without 15 and 13 teeth, presence of 53 and mesogression of 16. At the radiographic examination, the retention of 55, 15 and 13 was found, and also the incomplete transposition of 13 and 12. After deeply analyzing the case, the orthodontists decided the removal of 55 and aligning 15 and 13 to dental arch, placing a device with the system of direct cementing at the moment of the surgery. It was established a functional occlusion and an acceptable esthetics, particularly caring for the neighboring teeth and their soft tissues. Retentions are complex dental malocclusions, of difficult prognosis and treatment, mainly when they are multiple. They require study and multidisciplinary treatment (AU).

YouTube video analysis as a source of information for patients on impacted canine.

OBJECTIVE: To investigate video content on YouTube™ related to impacted canine and impacted canine surgery. MATERIALS AND METHODS: In this cross-sectional study, the term "impacted canine tooth" was searched on YouTube™. After excluding duplicates, irrelevant videos, non-English-language videos, no audio-no video contents, sixty-one videos were independently examined by 3 reviewers. Videos were categorized as "not useful", "slightly useful", "moderately useful", and "very useful" by using an 8-point score list for evaluating the value of the videos in providing patients information about impacted canine teeth and surgery. Chi-square test was performed for categorical variables and differences between groups were compared with Kruskal-Wallis. Correlations were analysed using Spearman test. Statistical significance was set P<0.05. RESULTS: Most of the videos, 42.6%, n=26 were uploaded by healthcare professionals [dentists, orthodontists, surgeons] and 29,5%, n=18 were uploaded by laypersons for sharing personal experiences. There were 3 [4.9%] not useful videos, 15 [24.5%] slightly useful videos, 27 [44.2%] moderately useful videos, and 16 [26.2%] very useful videos. There was no significant difference between the viewing rate according to the source of upload [P=0.398>0.05]. There was a significant difference between the interaction index according to the source of upload. This difference was in the laypersons and the others [.033<05]. CONCLUSION: Healthcare specialists should be aware of the content of the video-sharing platforms and direct their patients to correct and reliable e-information resources.

First and second permanent molars with failed or delayed eruption: Clinical and statistical analyses.

INTRODUCTION: The aim of this work was to analyze data of patients with failed or delayed eruption of first and second permanent molars, to assess the effectiveness of the treatment methods used. METHODS: Epidemiologic and clinical data of 125 patients (mean age 14.08 ± 4.04 years) with 197 affected molars (30 first and 167 second molars) were retrospectively analyzed. The treatment outcome was known in 161 molars after patient drop-out (20 patients with 36 molars). The cases were categorized into 8 groups according to the choice of treatment: orthodontic uprighting, surgical-orthodontic uprighting, surgical uprighting, surgical repositioning, surgical exposure, first or second molar extraction, third molar extraction, or removal of pathologic conditions. RESULTS: The overall treatment outcome was positive in 141 molars (87.6%). It was positive in all cases treated with orthodontic uprighting (7 molars), surgical exposure (10 molars), surgical uprighting (38 molars), and surgical repositioning (8 molars), but it was significantly lower for surgical-orthodontic uprighting (34/48 molars, 70.8%). The positive outcome was significantly lower for inclusion (52/68 molars, 76.5%) than for early-diagnosed condition (11/11 molars, 100%) and retention (78/82 molars, 95.1%), and for total bone crown coverage (21/28 molars, 75.0%) than for osteomucosal or mucosal crown coverage (120/133 molars, 90.2%). CONCLUSIONS: This study demonstrates that an early diagnosis results in a better outcome regardless of the treatment used, with the number of cases with a positive outcome being higher in younger patients.

[Clinical and imaging features of 36 odontogenic keratocysts associated with an impacted tooth].

PURPOSE: To analyse the imaging features of odontogenic keratocysts (OKCs) associated with an impacted tooth. METHODS: Clinical and radiological data of 235 cases with OKCs were respectively investigated, with emphasis on imaging features of 36 OKCs, which were associated with an unerupted tooth. RESULTS: In 36 cases of OKCs associated with an impacted tooth, the ratio of male to female was 1.77:1, and molar-ramus was involved in 26 cases (72.22％). OKCs in association with an unerupted tooth occurred mostly in patients ranging from 20 to 30 years (19 cases, 52.8％). There were 27 cases (75％) of unilocular and 9 cases (25％) multilocualr radiolucency. Thirteen cases (36.11%) were related to the crown of the impacted teeth, and the unerupted teeth also were impacted as a result of malposition in which the entire teeth appeared to be enveloped by cysts (15 cases, 41.67%), or adjacent to cyst wall (8 cases, 22.22%). CONCLUSIONS: Radiographically, one of the most imaging features of OKCs in association with an unerupted tooth is that its entire tooth appears to be enveloped by cyst or adjacent to cyst, while pericoronal radiolucencies surrounding an impacted tooth are rarely seen.

The Treatment Strategy of Cleidocranial Dysplasia: Combined Orthodontic and Orthognathic Treatment.

Cleidocranial dysplasia is a rare autosomal-dominant condition that affects ossification. The main symptoms of this cleidocranial dysplasia patient include craniofacial abnormalities, hypoplasia of clavicles, narrow thorax, retarded exfoliation of deciduous teeth, retarded eruption of permanent teeth, and multiple impacted supernumerary teeth. The aim of this treatment was to correct the craniofacial abnormalities and provide an adequate functional reconstruction of the occlusion. The patient was treated with a multidisciplinary therapeutic protocol including removal of supernumerary teeth, surgical exposure of impacted teeth, orthodontic, and orthognathic surgery. After 6 years' follow-up, the treatment objectives of acceptable occlusion, normal function, and acceptable profile were achieved.

Orthodontic traction of impacted canines: Concepts and clinical application

ABSTRACT Orthodontic traction of impacted canines stands as a major challenge for Orthodontics. It is a relatively frequent clinical complaint which management, more often than not, requires a multidisciplinary approach. Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch, may frequently lead to complications involving supporting tissues, not to mention the long treatment time and high costs imposed to patients. In face of that, it is worth highlighting the relevance of early diagnosis as to intervene efficiently and as soon as possible. This paper presents a review of the main concepts involving prevalence, etiology and classification of impacted canines, and describes the different clinical management options that would help solve the problem. It illustrates the topic by presenting a treatment delivered to a 13 year 7 months old male patient, suffering from a Class II, division 2, left subdivision, malocclusion, associated to a deep bite and a prolonged retention of a primary upper canine caused by the impaction of the permanent tooth. Corrective orthodontic therapy was associated to a rapid maxillary expansion and to the use of a high pull headgear. Impacted canine was submitted to orthodontic traction and correctly positioned back into the arch. This approach proved to be efficient in meeting both functional and aesthetic goals.

RESUMO O tracionamento de caninos impactados representa um dos grandes desafios da Ortodontia. Trata-se de um problema clínico relativamente frequente, cujo tratamento muitas vezes requer uma abordagem multidisciplinar. A exposição cirúrgica do canino impactado e a complexa mecânica ortodôntica aplicada para alinhar o dente na respectiva arcada podem, com frequência, levar a complicações nos tecidos de suporte, sem mencionar o longo tempo de tratamento e os custos elevados para o paciente. Por isso, vale a pena ressaltar a importância dos diagnósticos precoces, para que a interceptação do problema seja feita o mais cedo possível e de maneira eficaz. O presente trabalho apresenta uma revisão dos principais conceitos envolvendo a prevalência, etiologia e classificação dos caninos impactados, e descreve os vários tipos de abordagem clínica para a resolução do problema. Ao final, ilustra o tema com a apresentação de um tratamento realizado em um paciente de 13 anos e 7 meses de idade, portador de má oclusão de Classe II, divisão 2, subdivisão esquerda, associado a mordida profunda, que apresentava retenção prolongada de um canino superior decíduo, devido à impacção de seu sucessor permanente. O tratamento ortodôntico corretivo foi associado à expansão rápida de maxila e ao uso de aparelho extrabucal de tração cervical. O canino impactado foi tracionado ortodonticamente e posicionado corretamente na arcada. Essa abordagem foi eficiente para atingir as metas funcionais e estéticas propostas.