CASE STUDY Fig. 3 Fig. 2 “There are many steps in the process to assess, prevent and treat ectopic canines. Some of these steps include proper radiographic techniques including the use of panoramic radiographs, periapical radiographs and cone beam technology.” the cantilever. Architectural cantilevers are mostly static elements that resist forces. Orthodontic cantilevers are also extended beyond points of support but are not static – they are used to exert forces. Accepting those differences, cantilever or whip springs have been used in orthodontics for many years. This article describes an orthodontic case involving a severely ectopic and impacted canine. The extent of the ectopic position resulted in the transposition of the canine with a central incisor. A cantilever or whip spring was used to erupt the impacted tooth. Fig. 4 Fig. 5 panoramic radiograph, Fig. 1), showed an ectopically developing maxillary right canine. An orthodontic evaluation was recommended, but not pursued for eight months. Orthodontic records were obtained (Figs. 2-4). The patient’s diagnoses included: • Convex, Class II profile • Skeletal Class II relationship, according to her clinical findings • Dental Class I canine and molar relationship • Anterior crossbite • Dental deep bite • Maxillary crowding • Delayed eruption of UR1 • Severely ectopic and likely impacted UR3, transposing with the UR2 • Maxillary constriction Treatment Objectives & Progress The Phase I treatment plan included maxillary expansion with a soldered maxillary expansion appliance and 2x4 mechanics to correct the crossbite. Extraction of the primary canines was planned as well. The objectives of treatment were to alleviate the crossbite and begin to address the ectopically developing canine. Palatal expansion was begun 5 months after the consultation, at age 9 years 1 month. 24 turns were prescribed and a lower lingual hold-ing arch was placed. (Fig .5) Diagonosis & Etiology An 8-year, 8-month-old female patient presented for an orthodon-tic evaluation because of an anterior crossbite, evaluation for space main-tenance and because of a severely ectopic maxillary right canine. Prior to this timepoint, a panoramic radiograph, taken at age 8 (see the initial non-digital www.orthodontics.com Spring 2023 9
Journal of the American Orthodontic Society Spring 2023: Page 9
