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Tying severely retroclined lat-eral incisors or ectopic teethinto the main archwire can beboth difficult and problematic.1First, the forces used to createspace in the arch can oppose thoseneeded to align the teeth. Thiscan cause binding and notchingof the wire at the locations of themost misaligned teeth, resulting

in increased friction and thusnegating the archwires superelas-tic properties.2,3 Potentially harm-ful forces are also placed on theanchorage unit when aligningectopic teeth.4 Furthermore,bonding brackets to the buccal

surfaces of ectopic teeth can resultin premature occlusal contactsthat can dislodge the brackets.

Although one method ofavoiding these biomechanicalproblems has been recommend-ed,5 the development of self-ligat-ing attachments suggests anotherstrategy, which we describe here.

Diagnosis andTreatment Plan

A 10-year-old girl presentedwith the chief complaint of unes-thetic dental appearance (Fig. 1).Although she had experienced a

trauma to the maxillary left cen-tral incisor, there was no contra-indication to orthodontic therapy.Intraoral examination revealedmild maxillary skeletal constric-tion, crowding in the maxillaryarch, and partial closure of themaxillary left lateral incisor erup-tion space due to the migration ofadjacent teeth. A Class I molar

relationship was present (Table 1),but the mandibular dental midlinewas deviated to the left. The max-illary right canine was eruptingectopically, and the right lateralincisor was in crossbite andseverely retroclined relative to the

VOLUME XLIV NUMBER 3 171

CASE REPORT

A Simple Method for AligningRetroclined or Ectopic Teeth

MAURO COZZANI, DDS, MSDLUCA LOMBARDO, DDSANTONIO GRACCO, DDSGIUSEPPE SICILIANI, DDS

2010 JCO, Inc.

Drs. Cozzani, Lombardo, and Gracco are Visiting Professors and Dr. Siciliani is Chair, Department of Orthodontics, University of Ferrara, Italy. Dr.Cozzani is also in the private practice of orthodontics at Via Fontevivo 21N, La Spezia, Italy; e-mail: [email protected].

Dr. SicilianiDr. GraccoDr. LombardoDr. Cozzani

2010 JCO, Inc. May not be distributed without permission. www.jco-online.com

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A Simple Method for Aligning Retroclined or Ectopic Teeth

Fig. 1 10-year-old female patientwith Class I occlusion, maxillaryconstriction and crowding, ectop-ically erupting maxillary right ca-nine, and retroclined maxillaryright lateral incisor in crossbitebefore treatment.

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other upper incisors.Two treatment options were

considered. The first involvedextraction of the maxillary pre-molars to resolve the crowdingand allow the canines to eruptwithout flaring of the incisors.The second option was to expandboth arches by means of fixedappliances, with no extractions.

To maintain the patients profile,and because the maxillary expan-sion was expected to produce suf-ficient space for alignment, thesecond option was chosen.

Treatment Progress

Leveling and alignmentwere begun in the mandibular

arch with full fixed appliances(Fig. 2). Eight weeks later, theupper right canine had eruptedenough to bond the maxillaryteeth. We used self-ligatingBidimensional brackets6 (Time2*) except on the retroclined lat-eral incisor, where we bonded astainless steel cleat to the lingualsurface (Fig. 3). An extremelythin, flexible archwire (.012"nickel titanium) was inserted

through the bracket slots and bent

Fig. 2 Self-ligating brackets bonded in lower arch for initial leveling and alignment.


Cozzani, Lombardo, Gracco, and Siciliani

Fig. 3 After eight weeks of treatment, self-ligating brackets bonded in upper arch, with stainless steel cleatbonded to lingual surface of right lateral incisor.

*American Orthodontics, 1714 CambridgeAve., Sheboygan, WI 53081; www.americanortho.com.

TABLE 1CEPHALOMETRIC DATA

Pretreatment Post-Treatment Norm

SNA 79.9 79.7 82.0

SNB 77.7 77.5 80.9FMA (MP-FH) 31.5 29.7 26.0ANB 2.2 2.2 1.6U1-SN 108.8 116.7 101.3L1-MP 84.7 94.5 95.0

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around the cleat to progressivelyalign the teeth.

This method has severaladvantages. The forces used areextremely light, but effectivebecause friction is controlled.Binding is prevented by limitingthe wire to one-point contacts

with the brackets and by increas-ing the interbracket distances.The use of a lingual cleat reducesthe possibility of bond failure,since it is unnecessary to tie liga-tures that would press on thearchwire. This system is bothcomfortable for the patient and

straightforward for the clinician,who need only cut off the excesswire at the most distal of thebanded teeth during each follow-up visit.

Once the ectopic canine andretroclined lateral incisor hadbeen brought into the arch (Fig.

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Fig. 4 After 20 weeks of treatment, ectopic maxillary right canine and retroclined right lateral incisor nearlyin position.

Fig. 5 After nine months of treatment, maxillary right lateral incisor bracket rotated 180 for correction ofroot inclination.

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4), the lateral incisor was bondedwith a self-ligating Time 2 brack-et with an .018" .025" slot. Thearchwire sequence was: .012" and.014" nickel titanium* for levelingand alignment; .016" .025"nickel titanium HA* to correctrotations and provide initialtorque control; and .018" .022"stainless steel SG** for finetorque control and finishing.

After nine months of treat-

ment, the bracket on the maxil-lary right lateral incisor wasrotated 180 to correct the rootinclination (Fig. 5). In the Bi-dimensional technique, the lat-eral incisor bracket typically hasa torque of 8; rotating it pro-duced a torque of 8, which per-mitted overcorrection of theradicular inclination. Torque

could be controlled by using afull-size archwire (Fig. 6).

Treatment Results

After 24 months of treat-ment, the patient had Class Icanine and molar relationshipswith a minor Class III tendencyon the right (Fig. 7). Overbite andoverjet relationships were ideal.Cephalometric evaluation indi-

cated an increase in maxillary andmandibular incisor inclination,but no change in ANB (Table 1).

Upper wraparound and lowerHawley retainers were delivered.

Conclusion

This case demonstrates thatseverely misaligned teeth can bequickly and efficiently broughtinto the arch by using self-ligating

brackets with thin, resilient nickeltitanium archwires bent aroundcleats bonded to the lingual sur-

faces of the most misaligned teeth.A self-ligating bracket can berotated and used with a full-sizearchwire for fine torque control.

REFERENCES

1. Cozzani, M.; Lanteri, C.; Fedi, M.;Montera, V.; Zappulla, F.; and Rosa,M.: Metodo pratico per vincere il morsoincrociato di un dente, Mondo Ortod.6:733-737, 1991.

2. Kusy, R.P. and Whitley, J.Q.: Inf luenceof archwire and bracket dimensions on

sliding mechanics: Derivations anddeterminations of the critical contactangles for binding, Eur. J. Orthod.21:199-208, 1999.

3. Glenys, A.; Thorstenson, B.S.; andKusy, R.P.: Effect of archwire size andmaterial on the resistance to sliding ofself-ligating brackets with second-orderangulation in the dry state, Am. J.Orthod. 122:295-305, 2002.

4. Stoner, M.M.: Force control in clinicalpractice, Am. J. Orthod. 46:163-168,1960.

5. Hain, M.; Dhopatkar, A.; and Rock, P.:The effect of ligation method on frictionin sliding mechanics, Am. J. Orthod.

123:416-422, 2003.6. Gianelly, A.A.; Bednar, J.R.; and Dietz,V.S.: A bidimensional edgewise tech-nique, J. Clin. Orthod. 19:418-421, 1985.


Cozzani, Lombardo, Gracco, and Siciliani

Fig. 6 Improvement in maxillary right lateral incisor torque eight weeks later.

*American Orthodontics, 1714 CambridgeAve., Sheboygan, WI 53081; www.americanortho.com.

**Dentsply GAC International, 355 Knicker-bocker Ave., Bohemia, NY 11716; www.gacintl.com.

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Fig. 7 A. Patient after 24 months of treatment. B. Superimposition of pre- and post-treatment cephalometrictracings.

A B

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