Korean J Orthod.  2015 Nov;45(6):322-333. 10.4041/kjod.2015.45.6.322.

Orthodontic treatment of a transposed maxillary canine and first premolar in a young patient with Class III malocclusion

• Gracco A
• Siviero L
• Perri A
• Favero L
• Stellini E

• KMID: 2130594
• DOI: http://doi.org/10.4041/kjod.2015.45.6.322

Abstract

A 12-year-old girl was referred to our clinic for evaluation of an unaesthetic dental appearance. All permanent teeth were erupted, while the deciduous maxillary right canine was retained. Cone-beam computed tomography revealed a complete transposition of the maxillary left canine and first premolar involving both the crowns and the roots. Initial cephalometric analysis showed a skeletal Class III pattern, with a slight maxillary retrusion and a compensated proclination of the upper incisors. The patient's teeth were considered to be in the correct position; therefore, we decided to attempt treatment by correcting the transposition and using only orthodontic compensation of the skeletal Class III malocclusion. After 25 months of active orthodontic treatment, the patient had a Class I molar and canine relationship on both sides, with ideal overbite and overjet values. Her profile was improved, her lips were competent, and cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. The final panoramic radiograph showed that good root parallelism was achieved. Two-year follow-up intraoral photography showed stable results.

Keyword

Three-dimensional diagnosis; Dental transposition; Young patient; Class III malocclusion

MeSH Terms

Bicuspid*
Child
Compensation and Redress
Cone-Beam Computed Tomography
Crowns
Female
Follow-Up Studies
Humans
Incisor
Lip
Malocclusion*
Molar
Overbite
Photography, Dental
Retrognathia
Tooth

Figure

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  Figure 1 Pretreatment records: facial and intraoral photographs.

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  Figure 2 Pretreatment records: dental casts.

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  Figure 3 Pretreatment records: radiographs and cephalometric tracings.

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  Figure 4 Three-dimensional reconstruction of the maxilla, with transposition of the left canine and first premolar.

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  Figure 5 Intraoral photographs at bonding stage. A high-torque central incisor bracket (+17o torque value) was bonded to the first left premolar to facilitate the correction of the transposition.

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  Figure 6 Intraoral photographs of the left side, showing the positive crown torque of the first premolar. The palatal cuspid of the tooth is extruded compared with the buccal cuspid of the same tooth.

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  Figure 7 Surgical procedure. A, Intraoral photo of the surgical exposure of the left canine; B, mucosal flap closed over the canine.

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  Figure 8 Post-treatment records: radiographs and cephalometric tracings (black, before treatment; red, after treatment).

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  Figure 9 Post-treatment records: facial and intraoral photographs.

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  Figure 10 Post-treatment records: dental casts.

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  Figure 11 Two-year follow-up photographs: facial and intraoral photographs.

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  Figure 12 Three-dimensional image of the absence of progression of left first premolar (2.4) root resorption.

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  Figure 13 Three-dimensional image of root placement in maxillary medullar bone.

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