A Simplified Distraction Device for

Unilateral Canine Distalization

A Case Report


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INDIAN DENTAL ACADEMY

Leader in continuing dental education
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A 21 yr old male patient reported to the department.

Chief Complaint Malaligned teeth.

Roth 018 prescription was used.

Initial alingment and leveling was done and
completion of Stage 1 achieved.

During Stage 2, the left maxillary canine retracted
completely but the right canine refused to shift from
its original position.


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What happened???
1. The canine bracket was inverted to minimize the cortical
anchorage.
2. An anchorage device was placed to distalize the canine, but
in vain.
3. The tooth was firm and gave a dull sound on percussion.
4. The patient was diagnosed to have an ankylosed right
maxillary canine.
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Whats this???
Root Resorption observed on the
distopalatal aspect of the ankylosed
canine.
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ANKYLOSIS???
Ankylosis of teeth occurs due to anatomic fusion of
cementum

or dentin with the alveolar bone.
The pathogenesis of ankylosis

is unknown and may be
secondary to one of the many factors.
Example - trauma,

injury, chemical or thermal irritation, genetic influence
In these circumstances orthodontic tooth movement

is
impossible and surgical repositioning

of the ankylosed
tooth is required.
Proffit WR, Am J Orthod 1981
Pelias MZ, Clin Genet 1985
Epker BN, Am J Orthod 1978
Medeiros PJ, AJODO 1997
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A revised treatment plan was then drafted,
to distalize the right canine using a

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How did we work out this design?
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Presurgical Measures
Since orthodontic tooth movement was
considered impossible, a

segmental
osteotomy and gradual distal movement of
the right

maxillary canine was planned.
Brackets on 15 & 13 were debonded and
16 was debanded prior to surgery.
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Surgical Measures
A segmental alveolar osteotomy was
performed in the upper right maxillary
segment in close proximity to the periodontal
space on the distal of 13 and the mesial of
15 to ensure complete retraction of the
canine with no interposed bone in between.



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After completing the osteotomy the
segment was

mobilized.
This operative site was then sutured.


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After surgery, the patient immediately reported
to the orthodontic department and was then
placed on a .
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Distraction Schedule
The first activation was done
3 days post surgery.

Screw was turned twice a
day, creating 0.5

mm distal
movement per day.

Distraction continued for 15
days.

Total amount of distal
movement was 7 mm in the
first premolar region.

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After the canine was distalized
completely, 13 & 15 were
rebonded and 16 was
rebanded.

17 x 25 NiTi wire was placed
with continuous ligation from
13 to 16.

After 7 days, we replaced the
17 x 25 NiTi archwire with 17 x
25 S.S. archwire with
continuous ligation from 13 to
16.

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Outcome
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There are two alternatives to consider for distraction:

the use of horizontal elastics
the fixed screw type distractor


With the use of horizontal elastics,

control of the distraction rate is
difficult.

Possible complications of the segmental osteotomy are
Periodontal defects
Loss of vitality of teeth
Loss of

blood supply (to both teeth and alveolar bone)
White RP, Surgical-orthodontic Treatment. St Louis: Mosby, 1991

Careful surgical procedure can avoid the complications with the adjacent
teeth.

Gradual distraction of the segment might be advantageous to

the blood
supply of the mobilized segment.


Discussion
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Conclusion

It is possible to distalize the canine using a
.

Advantages of :
Economical.
Simple to fabricate.
The design is not bulky.
Not technique sensitive.
Good patient compliance.

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thank you !!!
niravpatel@teethcarecentre.com



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