Glasl, Bettina

Hourfar, Jan

Ludwig, Björn

Ludwig, Gregory

English

Northumbria University Research Portal

Citation: Ludwig, Björn, Hourfar, Jan, Glasl, Bettina and Ludwig, Gregory (2013) Relocating canines  into  the  dental  arch:  the  role  of  self-litigating  brackets  with  additional  slots. Orthodontic Products. pp. 76-83. ISSN 1097-797X Published by: NovicomURL:  http://www.orthodonticproductsonline.com/orp-clini... <http://www.orthodonticproductsonline.com/orp-clinical-tips/15549-relocating-canines-into-the-dental-arch>This  version  was  downloaded  from  Northumbria  Research  Link: http://nrl.northumbria.ac.uk/11690/Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University’s research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners.  Single copies of full items can be reproduced,  displayed or  performed,  and given to  third parties in  any format  or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well  as a hyperlink and/or URL to the original metadata page. The content must  not  be changed in any way. Full items must not be sold commercially in any format or medium without  formal  permission  of  the  copyright  holder.   The  full  policy  is  available  online: http://nrl.northumbria.ac.uk/policies.htmlThis document may differ from the final, published version of the research and has been made available online in accordance with publisher policies. To read and/or cite from the published version of the research, please visit the publisher’s website (a subscription may be required.)Citation:  Ludwig,  B., Hourfar,  J., Glasl,  B. and Ludwig,  G. (2013) Ludwig,  B., Hourfar,  J., Glasl, B. &  Ludwig, G. (2013)"Relocating canines into the dental  arch: the role of self-litigating  brackets  with  additional  slots",  Orthodontic  Products,  pp.76-83. Orthodontic  Products. pp. 76-83. ISSN 1097-797XPublished by: Torrance, CA : Novicom, Inc.,URL: http://www.orthodonticproductsonline.comThis  version  was  downloaded  from  Northumbria  Research  Link:  http://nrl.northumbria.ac.uk/11690/Northumbria  University  has  developed Northumbria  Research  Link  (NRL)  to  enable users to access the University’s research output.  Copyright  © and moral  rights  for  items on NRL  are retained by the individual  author(s) and/or other  copyright  owners.  Single  copies of full  items can be reproduced, displayed or performed, and given to third  parties  in  any  format  or  medium  for  personal  research or  study,  educational,  or  not-for-profit  purposes without  prior  permission  or  charge,  provided  the  authors,  tit le  and  full  bibliographic  details  are  given,  as  well  as  a  hyperlink  and/or  URL  to  the  original  metadata  page. The content  must  not  be changed in  any way.  Full  items must  not  be sold commercially  in  any format  or medium  without  formal  permission of the copyright  holder.  The full  policy is available online: http://nrl.northumbria.ac.uk/policies.htmlThis document  may differ  from the final,  published version of the research and has been made available online in  accordance with  publisher  policies. To read and/or cite from the  published  version  of the  research,  please visit  the  publisher’s  website  (a subscription  may be required.)ORTHODONTIC PRODUCTS  /  April •  May 2013 orthodonticproductsonline.com76 Apart from mandibular third molars, maxillary canines are most frequently affected by dislocation, triggering the need for therapeutic treat-ment. Not including wisdom teeth, maxil-lary canines represent about 60% of teeth selected for relocation. Among the patholog-ical causes are shortage of space and erup-tion problems, as well as an atypical germ situation. Furthermore, genetical causes are often discussed. Particularly relevant in this context is the so-called guidance theory because it emphasizes the role of lateral inci-sors as a central stabilizing factor that allows for alignment of canine teeth, which in turn is of high importance for other teeth.1-2 Physiological eruption of upper teeth usually takes place at a physical age of about 11.5 years.3 In the majority of cases, this happens on both sides at about the same time. Around 10% of cases, however, reveal a difference of up to 1 year in direct compar-ison of time of eruption at both sides. The prevalence rate of dislocation of maxillary canines is about 0.8% to 2.3%, with the rate of female cases slightly higher.4 Moreover, 8% of patients are affected by bilateral relo-cation. About one-third of retained canine teeth are located in a labial position within the alveolar process, and about two-thirds are located in palatal positions.5 Clinically, dislocation of canine teeth is often easy to identify even without medical imaging because vestibular canines may be palpated unilaterally. Further indicators could be peg-shaped lateral incisors or their aplasia. The latter case imposes an obvious excess of space. X-ray radiographs providing an overview of the patient’s teeth highlight a generally better prognosis for successful integration if the angle between teeth axis and occlusal plane is higher than 45°. In turn, success-ful orthodontic integration of dislocated canines allows preservation of functionally very important canines.Practical ConsiderationsPrior to any relocation of canine teeth, a surgical cut-down is usually required. This can be implemented via open or closed The role of self-ligating brackets with additional slotsBY BJÖRN LUDWIG, DMD, MSD; JAN HOURFAR, DMD, MSD; BETTINA GLASL, DMD, MSD; AND GREGORY LUDWIG, PhD, MBA, BA (HONS), BBAThe role of self-ligating brackets with additional slotsBJÖRN LUDWIG, DMD, MSD, is in private practice in Traben-Trarbach, Germany. He is scientific coor-dinator at the University Homburg/Saar. He can be reached at bludwig@kieferorthopaedie-mosel.de.JAN HOURFAR, DMD, MSD, is in a private practice in Reinheim, Germany. He can be reached at hourfar@t-online.de. BETTINA GLASL, DMD, MSD, has a private practice together with Björn Ludwig in Traben-Trarbach, Germany. She can be reached at bglasl@kieferorthopaedie-mosel.de.GREGORY LUDWIG, PhD, MBA, BA (Hons), BBA, is senior lecturer in the faculty of business and law at Northumbria University in the United Kingdom. He can be reached at g.ludwig@northumbria.ac.uk. Bracke ts  &  W i resRelocating Canines intothe Dental Archorthodonticproductsonline.com                                                                                                                       April  /  May 2013  /  ORTHODONTIC PRODUCTS 77ORTHODONTIC PRODUCTS  /  April •  May 2013 orthodonticproductsonline.com78 techniques, depending on localization of the respective tooth. Prompt active elongation is recommended in the postoperative period. The process of orthodontic gap opening has often been initiated at this point in time. Deep intra-osseous dislocation often neces-sitates prior extrusion; this could be realized using ballista springs,6 for example. Following sufficient extrusion of the teeth (aided by respective appliances), it can then be relocated into the dental arch. In theory, orthodontists can choose from a variety of options. However, some of these offer striking disadvantages. If the relocation “pulls” via an elastic main arch, strong recip-rocal side effects are to be expected, mainly affecting teeth neighboring the gap. This short-coming particularly applies in cases displaying strongly ectopic canines. On the other hand, if flexible sutures leading from ectopic teeth toward the rigid orthodontic arch are selected, poor esthetics and hygiene are often the result. Furthermore, a considerable decrease in pulling power can be predicted in such cases. Another option is a flexible parallel arch, in addition to the rigid orthodontic main arch within the bracket slot. The main disadvan-tage in this case is the friction and barrier to teeth movement, because the parallel arch has restricted movement. Reciprocal side effects, meanwhile, can have a negative impact on overall treatment success if, for example, palatal canines are buccally shifted via the extension of a quad helix. This is due to general difficulties in controlling shifting powers of quad helix structures. Too strong, nonphysiological pulling power may result in hyalinization and, in some cases, even total suspension of teeth movement. Root ankylo-sis is very rare in maxillary canines.7Advantages of SL Bracket Usage with Auxiliary Slots Self-litigating brackets with additional, auxiliary slots8 offer a good alternative to the above-discussed treatment options. Not all SL systems, however, are suitable. Inserting of additional parallel arches is often not fea-sible and would immediately result in dys-functional sealing caps. Forestadent’s Quick bracket system addresses this issue through a 0.016" x 0.016" auxiliary slot (Figure 1). This auxiliary slot thus aids any treatment and relocation of dislocated or ectopical canines. In addition, it has a number of major advan-tages. This is because it allows for insertion of parallel arches (eg, 0.012" NiTi) that can move freely almost without any friction, in cases of rigid orthodontic main arches in situ. In turn, this allows for the release of continuous physiological pulling power, effectively preventing potential hyalinization and respectively longer treatment periods. Throughout the physiologically aided inte-gration of canine teeth, further physical teeth movements may then be realized at the rigid orthodontic main arch, offering a major contribution toward achieving overall treatment goals. Clinical ExamplesIn Figures 2 and 3, we see the vestibular aux-iliary slot technique post-laser (Sirona) gingivec-tomy. We used a Forestadent BioQuick bracket with auxiliary slot (dimension .016" x .016"). In Figure 2, we see the left vestibular retained canine within the attached gingiva following laser gingivectomy. The main arch was .019" x .025" SS and was combined with an overlay arch (.012" BioStarter) within the auxiliary slot.Bracke ts  &  W i resFigure 1: (A) Forestadent BioQuick bracket with auxiliary slot (dimension .016" x .016").Figure 2: Left vestibular retained canine within the attached gingiva following laser gingivectomy; main arch .019" x .025" SS and overlay arch (.012" BioStarter) within auxiliary slot.Figure 3: Gingiva position post-treatment. A circumscriptive gingivoplasty is planned for the integrated canine in order to improve aesthetic results.orthodonticproductsonline.com                                                                                                                                March 2013  /  ORTHODONTIC PRODUCTS 79ESi.DTwins         Digital         Auxiliaries         Practice Development          Education    Self Ligation         Aligners          Tubes/Bands           Archwires          Lab Products      An earthshaking product    set to turn the Orthodontic                World on its© 2013 Ormco Corporationormco.comormco.com/braceyourselfSEE WHAT’S SHAKINGAT THE AAO ANNUAL SESSION!Ormco Booth #1009ORTHODONTIC PRODUCTS  /  April •  May 2013 orthodonticproductsonline.com80 Bracke ts  &  W i resFigure 4: Vestibular auxiliary slot technique with closed exposure. (A) CBCT-data set in 3D volume image: high left vestibular canine - dislocated. (B) High vestibu-lar canine - dislocated; main arch .019" x .025" SS and overlay arch (.012" BioStarter) within auxiliary slot. (C) The canine tooth receives a +17° palatal torque bracket in the finishing phase. This is required to be able to move the canine tooth root into the palatal bone for achievement of healthy periodontal conditions.Figure 5: Vestibular auxiliary slot technique with closed exposure. (A) Vestibular highly dislocated canine tooth; main arch .019" x .025" SS and overlay arch (.012" BioStarter) within auxiliary slot. (B) Gingiva condition post-treatment completion. The gingival situation could have been further improved through more palatal torque at the canine tooth. Catching chain (Forestadent).AB CA Borthodonticproductsonline.com                                                                                                                       April •  May 2013  /  ORTHODONTIC PRODUCTS 81ORTHODONTIC PRODUCTS  /  April •  May 2013 orthodonticproductsonline.com82 Bracke ts  &  W i resInfalabMeanwhile, Figure 4 (page 80) shows a vestibular auxiliary slot technique with closed exposure. The CBCT data set in 3D volume image shows a dislocation of a high left ves-tibular canine (Figure 4A, page 80). Again the main arch was .019" x .025" SS, and the overlay arch (.012" BioStarter) was within the auxiliary slot (Figure 4B, page 80). In the final stage, the canine tooth received a +17° palatal torque bracket. This is required to be able to move the canine tooth root into the palatal bone to achieve healthy periodontal conditions (Figure 4C, page 80).Figure 5 (page 80) shows another vestibular auxiliary slot technique with closed expo-sure. In this case, the vestibular canine was dislocated. The main arch was .019" x .025" SS and the overlay arch (.012" BioStarter) within the auxiliary slot. Post-treatment, the gingival situation could have been further improved through more palatal torque at the canine tooth, but the x-ray post-treatment comple-tion showed satisfying results in relation to the canine position and root alignment.Figure 6: Palatal auxiliary slot technique. (A) CBCT data set in 3D imaging (upper jaw): considerable palatal dislocation of canine teeth. (B) Palatal relocated canine teeth post-laser exposure and adhesive attachment of catching chain; main arch .019" x .025" SS and overlay arch (.012" BioStarter) within auxiliary slot.  A Borthodonticproductsonline.com                                                                                                                       April •  May 2013  /  ORTHODONTIC PRODUCTS 83Finally, Figure 6 shows once more the palatal auxiliary slot technique. The CBCT data set in 3D imaging (upper jaw) shows a considerable palatal dislocation of the canine. The canine was exposed with a laser followed by adhesive attachment of a catching chain. The main arch was .019" x .025" SS, and the overlay arch (.012" BioStarter) was within the auxiliary slot. Post-active treatment, the gingival margin looks natural (Figure 7). ConclusionOverall, employment of SL brackets with additional auxiliary slots offers a number of advantages for integration of dislocated or ectopically positioned canines: relatively short treatment times due to easy operation and handling, uncomplicated insertion of parallel arches into the auxiliary slots, and decreased friction and physiological impact. OP411 E Coeur d’Alene Ave Ste 101    Coeur d’Alene, ID 83814        Scott Somers, NCARB, Architect (208) 391-7100         ssomers@arch-101.com arch-101.com References for this article are available  with Orthodontic Products’ interactive and online editions.Figure 4: (C) Natural gingiva position post-active treatment.

Relocating canines into the dental arch: the role of self-litigating brackets with additional slots

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