Aim: Generally when an orthodontist faces an extreme situation of a horizontal impacted canines, crossing the midline. The first thought comes in mind is surgical extraction to save time, money and avoid invitality at the end result. This case presents a challenge in orthodontics.
Subject and mechanics: a 15 years old girl with class one malocclusion. 90 degree horizontally, labially and unilaterally impacted canine was diagnosed. The treatment plan was to attempt dragging and up righting the canine back to its place. The risk of this procedure was the possibility of root resorption, loss of vitality and bone fenestration because of thin width of the alveolar bone surrounding the lower incisors.
Results: the treatment took 2.5 years. Starting with upper and lower fixed appliance, leveling and alignment and preparation to start canine retraction. Then surgical exposure and immediate retraction using power chain. Deligation of the lower incisors to provide smooth bypass of the canine to avoid bone fenestration and root resorption. Space regaining using open spring between lateral incisor and first premolar to provide a room for the new guest, followed by torque movement at the end. Successful dragging and up righting was achieved within 12 months, included frequent radiographic monitoring of the whole procedure. The tooth was tested for vitality at the end of retention, surprisingly, the canine was still alive.
Conclusion: correction of extremely impacted canine deserves the try for its merits as a vital member of occlusion.