Objective: To align ‘impossible’ bilateral transposed maxillary canines. A patient presented with a class III malocclusion and a reverse overjet of 2 mm. Radiographic examination revealed bilateral transposed maxillary canine teeth resorbing the roots of the upper central and lateral incisors. It was decided to attempt canine alignment. Two main problems needed to be overcome:
1) Movement of the lateral incisors into a horizontal position to allow the canines to pass labial to the lateral incisor roots.
2) The direction of traction had to be altered so that the canines would move horizontally over the lateral incisors. A jig was constructed to facilitate this.
Method: A simple removable appliance was used to correct the reverse overjet initially. A fixed appliance was then used. The lateral incisors were bonded with modified bracket position, designed to torque the roots horizontally. The canine teeth were exposed and gold chains bonded. The chain was then fed through a custom made jig which was inserted into the deciduous canine sockets. This augmented the direction of traction and drew the canine teeth over the lateral incisors into their correct position within the alveolus. The jig was then removed and vertical traction applied until the canines aligned. A lower fixed appliance was then used to detail the occlusion and finish treatment.
Result: Bilateral canine alignment was achieved over a period of 4 years.
Conclusion: Seemingly impossible alignment of displaced teeth can occur if time is spent devising the required devices to augment traction vectors.