Palatally displaced canine         Labially impacted canine        Mandibular impacted canine    slideshare.net/sylvaincha...
Side effect of straight wire                          mechanics in the 2  nd order                •         Detrimental si...
Da.Le.0309                                Da.Le.0710                                                •Mx: 3 segments       ...
Da.Le.150710                                                                Da.Le.181010                                  ...
Selective approach to canine                                 eruption                •         Main rigid archwire        ...
OOPS!                •         .016 supercable / .016 CNT         •.016 CNT / .016 X .022 CNT                             ...
Segmented approach to canine                        eruption                •         Main rigid archwire                 ...
Segmented approach to canine                        eruption                •         RPE and coil to open the space for t...
Segmented approach                    •      Cantilever on a                           removable appliance                ...
Flexible overlay wire                    •      Mx: .020 x .020 HA NiTi                          ! Auxiliary .016SC       ...
F.O.W.:15 weeks             Ma.La.19-03-09            Ma.La. 30-06-09©Dr Sylvain Chamberland
+7w              Ma.La. 30-06-09     Ma.La. 17-08-09©Dr Sylvain Chamberland
Ma.La. 17-08-09   Ma.La. 29-09-09©Dr Sylvain Chamberland
Detrimental side effect in 2nd order                                  •    High #23                                  •    ...
Canine impaction                •         Sentalloy coil spring to open space.                •         Main arch: .019 X ...
Canine impaction                •         TPA .032 X .032 TMA + mesial                          out on #18 and #26.       ...
Transpose #23                    •      Baliste cantilever                          ! .017 NiTi spring                    ...
Cantilever Arm                      Che.Ce 070409                     Che.Ce 210509©Dr Sylvain Chamberland
Cé.Ch. 21-05-09        •    Anchorage loss                              ! Should have been                                ...
•   Tooth #22 was not                              engaged since last 6                              weeks                ...
Cé. Ch.05-11-07         Cé. Ch.24-08-11, 9 months into retention          Cé. Ch.20-01-11, 2 months into retention        ...
Palatally displaced canine                                                         Ch.St-P. 0408                    •     ...
•      Ligatures are retighten                          ! Bonded button #23 buccal                                        ...
Ph.St-Pi. 08-04-09                    •     Transmucosa exposition «à la Kokich» Ph.St-Pi. 22-09-09                    •  ...
•       Sequence                                                     !    September: Engagement                          P...
Fixed appliances only                             Ch.St-P. 150408             Ch.St-P. 030211                             ...
Surgical approach                             Full thickness flap                             Ostectomy                    ...
Ga.Vi. 120510                                           Sentalloy uprighting spring                                       ...
Ga.Vi. 120510                                   Sentalloy uprighting spring                                   02-000-01& 0...
Ga.Vi. 120510                                              Sentalloy uprighting spring                                    ...
Ga.Vi.060411                                       At 47 weeks post ligation                              •   Rebond #13; ...
Remarks                    •     Pulling an impacted canine with fixed appliance, finger                          spring or ...
Remarks                    •     For more details about surgical exposure go to                    •     http://www.slides...
Ma-Ch.Po010910Canine ligated at 41weeks                                        Ma-Ch.Po061010      Ma-Ch.Po120111•   Can y...
Ma-Ch.Po060411                                                Ma-Ch.Po240811  Ma-Ch.Po120111                              ...
92 weeks                    •     Extraction: x, x, x, x      X   X                                                      X...
Ma-Ch.Po291009                                           92 weeks into tx                                            •   F...
Impacted Lower Canine                            •    What is your diagnosis?                                ! ...        ...
Impacted Lower Canine                            •   I apologies.                            •   The outcome, despite     ...
Impacted canine• Vestibular position • #12 & 22: displaced labially and distally • High vestibular bulge #23 • Labial vest...
•     #13 buccal to # 12                    •     #23 horizontal                    •     #33 mesially tipped   Fr. Tr 02-...
•     Extraction of 53, 63, 73, 83                                                         Fr. Tr 02-06                   ...
Fr. Tr 02-06                              Fr. Tr 09-06   Fr. Tr 03-07                    •     Extraction of 54, 64, 74, 8...
•      Tx:                          ! Ligature of 13, 23, 33                          ! Traction with removable appliance ...
•     Closed eruption technique                    •     Traction with elastics & Hawley                          Fr. Tr 1...
•     #13                     Fr. Tr 01-08©Dr Sylvain Chamberland
Fr. Tr 02-08©Dr Sylvain Chamberland
Fr. Tr 04-08                                         Fr. Tr 05-08©Dr Sylvain Chamberland
•      Ready for braces                                                   3rd order discrepancy                          !...
•       Mx: .016 supercable                    •       Md: .019 x .025 HA niti                          Fr. Tr 15-09-08©Dr...
•       Mx: .018 supercable                    •       Md: .020 x .020 HA niti                Fr. Tr 09-12-08©Dr Sylvain C...
•      Mx: .020 x.020 HA niti                          ! To initiate torque correction 12 & 22                    •      M...
•     Mx: .020 x .025 Niti Speed wire                    •     Note 3rd order problem to be                          corre...
•     Rebond #12 with special torque                    •     .020 x .025 niti SW Fr.Tr.11-05-09©Dr Sylvain Chamberland
•     Reassessment of bracket                          position                  Fr.Tr.17-08-09                    •     P...
•   May 09 to Feb 10                          •   Torque of 12 and 22                              has improved withFr.Tr....
• Open eruption technique                      ! Full thickness palatal flap                          "   Bonded button on ...
A-A Gag 0505                  A-A Gag 0605                  A-A Gag 0805               A-A Gag 1105                  A-A G...
A-A Gag 0805               A-A Gag 1105                    A-A Gag 1105©Dr Sylvain Chamberland
Palatally displaced canine                    Ca-A.Bo.04-05                    •      Age: 20 y                    •      ...
Ca-A.Bo.08-07                    Ca-A.Bo.10-07                    •     Bonded button + elastomeric chain                 ...
Ca-A.Bo.08-07       Ca-A.Bo.10-07         Ca-A.Bo.11-07©Dr Sylvain Chamberland
Ca-A.Bo.11-07          Ca-A.Bo.01-08©Dr Sylvain Chamberland        Ca-A.Bo.04-08
Ca-A.Bo.04-05                    •         Tx duration: 32 months                          Ca-A.Bo.11-08                Ca...
Transposed 23-22                 Au.De. 17-11-08               Au.De. 12-01-09©Dr Sylvain Chamberland
Au.De. 12-01-09                    •     Severe ALD©Dr Sylvain Chamberland
Au.De. 30-06-09. •md: .016 sent med                    •     #23 was pulled distally from the removable appliance         ...
Au.De. 30-06-09. •md: .016 sent med                          Au.De. 11-08-09. •md: .016 x.022 neost                       ...
Au.De. 17-11-08                     •     8 months into treatment                                                         ...
Au.De. 19-12-06                             Au.De. 23-02-09                       •     Easy, but it tooks times to get it...
2006                                                Au.De. 17-11-08                          2008                    •    ...
Pa.Be. 15-08-08                    •     Classe I                    •     Impacted #13                    •     Severe AL...
•     Retained #53                    •     Very heigh #13                    •     Impacted 8s                           ...
•     Bimaxillary protrusion                    •     Tx plan                          !©Dr Sylvain Chamberland
At 54 weeks                    •      #13 is erupting                    •      Side effects are noted                    ...
Pa.Be. 24-02-10                                            •    Forced eruption was stopped from sept 09 to               ...
Mx: .020 x .025 niti                                            Md: .020 x .025 SS                          Pa.Be. 24-02-1...
Mx: .016 sent                           Pa.Be. 01-09-10                Md: .020 x .025 SS                    •       Lower...
Pa.Be. 06-04-11                    •      Mx: .021 x .025 TMA (6 weeks)                          ! Does it slide? No!     ...
Pa.Be. 22-08-11                    •     154 weeks!!                    •     Retrospectively, I would use a removable app...
•     Fairly good root parallelism                                                         Pa.Be. 22-08-11©Dr Sylvain Cham...
©Dr Sylvain Chamberland
•     Shes happy©Dr Sylvain Chamberland
•     Next©Dr Sylvain Chamberland
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Treatment and management of impacted canine with speed appliance

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This lecture demonstrate the orthodontic management of impacted canines with SPEED Appliance (Self-ligating bracket).
A Segmented approach is describe as well as the use of cantilever auxiliary spring to pull the canine. One example surgical exposure of impacted canine is shown. The alternative use of removable appliance and cantilever spring prior to the fixed appliance is presented.

Treatment and management of impacted canine with speed appliance

  1. 1. Palatally displaced canine Labially impacted canine Mandibular impacted canine slideshare.net/sylvainchamberland
  2. 2. Side effect of straight wire mechanics in the 2 nd order • Detrimental side effect ! Intrusion and tipping of the canine and premolar toward the canine space ! Cant of the occlusal plane • Tx objective of canine extrusion ! To avoid side effects Sem. Ortho. 1: p24, 2001 & 3: p156, 2001©Dr Sylvain Chamberland
  3. 3. Da.Le.0309 Da.Le.0710 •Mx: 3 segments •016 Supercable in the auxilliary slot •Patient was instructed to wear ! elastic 3/3-4 •He didn’t... •Mx: 19x25 TMA, 17-22 •016 Supercable in the auxilliary slot •Patient was instructed to wear ! elastic 3/3-4©Dr Sylvain Chamberland Da.Le.0710
  4. 4. Da.Le.150710 Da.Le.181010 •After 6 weeks •Occlusal plane is leveled •Box loop will continue uprigthing of #13 Da.Le.300811 Patient went to Afghanistan 10 months August, 10 October, 10 August, 11©Dr Sylvain Chamberland
  5. 5. Selective approach to canine eruption • Main rigid archwire • Flexible overlay auxiliary wire • SPEED bracket ! Auxiliary slot and arch wire Sem. Ortho. 1: p24, 2001©Dr Sylvain Chamberland
  6. 6. OOPS! • .016 supercable / .016 CNT •.016 CNT / .016 X .022 CNT May 14 June 25©Dr Sylvain Chamberland
  7. 7. Segmented approach to canine eruption • Main rigid archwire ! To prevent mesial molar tipping • Cantilever spring ! Anterior extrusion, posterior intrusion ! Counterclockwise moment at the molar©Dr Sylvain Chamberland
  8. 8. Segmented approach to canine eruption • RPE and coil to open the space for the canine • Cantilever for canine extrusion • No intrusive side effect in the anterior region©Dr Sylvain Chamberland
  9. 9. Segmented approach • Cantilever on a removable appliance ! Excellent anchorage Fr.Tr.121107 15 w Fr.Tr.121107 26 w ! Very few, if any, side effects Fr.Tr.250208 Fr.Tr.120508©Dr Sylvain Chamberland
  10. 10. Flexible overlay wire • Mx: .020 x .020 HA NiTi ! Auxiliary .016SC Ma.La.19-03-09©Dr Sylvain Chamberland
  11. 11. F.O.W.:15 weeks Ma.La.19-03-09 Ma.La. 30-06-09©Dr Sylvain Chamberland
  12. 12. +7w Ma.La. 30-06-09 Ma.La. 17-08-09©Dr Sylvain Chamberland
  13. 13. Ma.La. 17-08-09 Ma.La. 29-09-09©Dr Sylvain Chamberland
  14. 14. Detrimental side effect in 2nd order • High #23 • Cl II elastic to enhance Al.Du. 15-05-09 extrusion + distallization Al.Du. 05-08-09 of 23 + protraction of 36 • But ! Forces & moments move teeth©Dr Sylvain Chamberland
  15. 15. Canine impaction • Sentalloy coil spring to open space. • Main arch: .019 X .025 CNT. • Auxiliary wire: .016 CNT.©Dr Sylvain Chamberland
  16. 16. Canine impaction • TPA .032 X .032 TMA + mesial out on #18 and #26. • Elastomeric chain from molar hook to 2nd premolar. • Coil spring to open space.©Dr Sylvain Chamberland
  17. 17. Transpose #23 • Baliste cantilever ! .017 NiTi spring Ce.Che. 07-04-09 Ce.Che. 12-01-09©Dr Sylvain Chamberland Could be used with PDC
  18. 18. Cantilever Arm Che.Ce 070409 Che.Ce 210509©Dr Sylvain Chamberland
  19. 19. Cé.Ch. 21-05-09 • Anchorage loss ! Should have been anticipated ! Poor collaboration with elastic wear did not help Cé. Ch.16-06-09©Dr Sylvain Chamberland
  20. 20. • Tooth #22 was not engaged since last 6 weeks • Transposition is corrected Cé. Ch.15-09-09 Cé. Ch.16-06-09©Dr Sylvain Chamberland
  21. 21. Cé. Ch.05-11-07 Cé. Ch.24-08-11, 9 months into retention Cé. Ch.20-01-11, 2 months into retention • Lack of septal bone between 22-23 need to be monitored • Root resorption is noted©Dr Sylvain Chamberland
  22. 22. Palatally displaced canine Ch.St-P. 0408 • Full thickness palatal flap • Create opening through palatal mucosa • At 4 months ! Main arch: .020 x .020 HA niti Ch.St-P. 27-06-08 ! auxiliary wire: .016 HA niti©Dr Sylvain Chamberland
  23. 23. • Ligatures are retighten ! Bonded button #23 buccal Ch.St-P. 06-10-08 • Canine bonded at 35 weeks ! auxiliary .016SC engaged • At 11 months ! Canines are rebonded Ch.St-P. 08-04-09©Dr Sylvain Chamberland
  24. 24. Ph.St-Pi. 08-04-09 • Transmucosa exposition «à la Kokich» Ph.St-Pi. 22-09-09 • Removable appliance & finger spring cantilever Ph.St-Pi. 22-09-09©Dr Sylvain Chamberland
  25. 25. • Sequence ! September: Engagement Ph.St-Pi. 22-09-09 ! October:1st control Ph.St-Pi. 20-10-09 ! November: 2nd control ! December, at 13 weeks: Bond 13 & 23 ! February, at 19 weeks Ph.St-Pi. 03-02-10 Ph.St-Pi. 23-12-09©Dr Sylvain Chamberland
  26. 26. Fixed appliances only Ch.St-P. 150408 Ch.St-P. 030211 144 weeks Removable cantilever spring & fixed appliances Ph.St-P. 080409 Ph.St-P. 310811 120 weeks©Dr Sylvain Chamberland
  27. 27. Surgical approach Full thickness flap Ostectomy Curettage of the dental follicle Opening window through the mucosa Flap closed + sutured Ga.Vi. 120510©Dr Sylvain Chamberland
  28. 28. Ga.Vi. 120510 Sentalloy uprighting spring 02-000-01& 00 Sentalloy rotating spring 10-003-01;02; 03;04 Ga.Vi. 230610 Ga.Vi. 260510 At 6 weeks At 2 weeks Ga.Vi. 040810 Ga.Vi. 150910 At 12 weeks©Dr Sylvain Chamberland At 18 weeks
  29. 29. Ga.Vi. 120510 Sentalloy uprighting spring 02-000-01& 00 Sentalloy rotating spring 10-003-01;02; 03;04 Ga.Vi. 150910 Ga.Vi.261010 At 18 weeks At 24 weeks •Bond #13 ".016 SC™ aux. wire. Ga.Vi.151210 Ga.Vi.020211 Ga.Vi.230211 At 31 weeks©Dr Sylvain Chamberland At 38 weeks At 41 weeks
  30. 30. Ga.Vi. 120510 Sentalloy uprighting spring 02-000-01& 00 Sentalloy rotating spring Ga.Vi.230211 10-003-01;02; 03;04 At 41 weeks • Rebond 13; .016 sent. aux. wire Ga.Vi.060411 At 47 weeks post ligation©Dr Sylvain Chamberland
  31. 31. Ga.Vi.060411 At 47 weeks post ligation • Rebond #13; .016 sent.; #13 is engaged Ga.Vi.180511©Dr Sylvain Chamberland At 53 weeks post ligation; 75 weeks into treatment
  32. 32. Remarks • Pulling an impacted canine with fixed appliance, finger spring or auxilliray wire is a good and predictable approach • However, using a removable appliance with SS cantilever spring may be faster to bring the canine at the level of the mucosa©Dr Sylvain Chamberland
  33. 33. Remarks • For more details about surgical exposure go to • http://www.slideshare.net/sylvainchamberland/2-0- ruptions-ectopiques-approche-chirurgicale • 2 0 Éruptions ectopiques_Management chirurgical des canines incluses©Dr Sylvain Chamberland
  34. 34. Ma-Ch.Po010910Canine ligated at 41weeks Ma-Ch.Po061010 Ma-Ch.Po120111• Can you explain why the canine is rotated? Evolution of the Evolution at 19• In which direction? canine in 5 weeks• Why the force couple is done this weeks post ligation way at 19 weeks? post ligation©Dr Sylvain Chamberland
  35. 35. Ma-Ch.Po060411 Ma-Ch.Po240811 Ma-Ch.Po120111 31 weeks post 51 weeks post Evolution at 19 ligation ligation weeks post ligation 72 weeks into tx 92 weeks into tx©Dr Sylvain Chamberland
  36. 36. 92 weeks • Extraction: x, x, x, x X X X X • Surgical exposure of 13 X was delayed X • Ligation could have been done from start and traction initiated with a removable appliance and cantilever spring©Dr Sylvain Chamberland
  37. 37. Ma-Ch.Po291009 92 weeks into tx • Finishing bends Initial June 2010 Ma-Ch.Po240811©Dr Sylvain Chamberland
  38. 38. Impacted Lower Canine • What is your diagnosis? ! ... • Full thickness flap.Ch.Tr0610 Should have been ligate Ch.Tr260810 enough apically to expose the crown 9 weeks ! #33 engagedCh.Tr071010 • Healing at 7 weeks Ch.Tr251010 ! Finger spring initiated 13 weeks I let the ginviva heal for 3 months. The keratinized gingival bridge has gone A bracket was bonded in late march©Dr Sylvain Chamberland 2011 Ch.Tr231110
  39. 39. Impacted Lower Canine • I apologies. • The outcome, despite 9 weeks nice eruption of the canine, is the worse case Ch.Tr251010Ch.Tr260810 scenario in term of keratinized attached gingiva 13 weeks • A keratinized tissue Ch.Tr231110 graft is necessaryCh.Tr040411©Dr Sylvain Chamberland
  40. 40. Impacted canine• Vestibular position • #12 & 22: displaced labially and distally • High vestibular bulge #23 • Labial vestibular bulge #33 Fr. Tr 02-06
  41. 41. • #13 buccal to # 12 • #23 horizontal • #33 mesially tipped Fr. Tr 02-06©Dr Sylvain Chamberland
  42. 42. • Extraction of 53, 63, 73, 83 Fr. Tr 02-06 Fr. Tr 09-06©Dr Sylvain Chamberland
  43. 43. Fr. Tr 02-06 Fr. Tr 09-06 Fr. Tr 03-07 • Extraction of 54, 64, 74, 84 • Favorable auto correction of 13 & 33 • Fr. Tr 10-07 23 still horizontal©Dr Sylvain Chamberland
  44. 44. • Tx: ! Ligature of 13, 23, 33 ! Traction with removable appliance Fr. Tr 10-07©Dr Sylvain Chamberland
  45. 45. • Closed eruption technique • Traction with elastics & Hawley Fr. Tr 11-07©Dr Sylvain ChamberlandFr. Tr 10-07
  46. 46. • #13 Fr. Tr 01-08©Dr Sylvain Chamberland
  47. 47. Fr. Tr 02-08©Dr Sylvain Chamberland
  48. 48. Fr. Tr 04-08 Fr. Tr 05-08©Dr Sylvain Chamberland
  49. 49. • Ready for braces 3rd order discrepancy ! Tx initiated july-08 Fr. Tr 06-08©Dr Sylvain Chamberland
  50. 50. • Mx: .016 supercable • Md: .019 x .025 HA niti Fr. Tr 15-09-08©Dr Sylvain Chamberland
  51. 51. • Mx: .018 supercable • Md: .020 x .020 HA niti Fr. Tr 09-12-08©Dr Sylvain Chamberland
  52. 52. • Mx: .020 x.020 HA niti ! To initiate torque correction 12 & 22 • Md: .020 x.020 HA niti Fr. Tr. 03-02-09©Dr Sylvain Chamberland
  53. 53. • Mx: .020 x .025 Niti Speed wire • Note 3rd order problem to be corrected Fr.Tr. 19-03-09©Dr Sylvain Chamberland
  54. 54. • Rebond #12 with special torque • .020 x .025 niti SW Fr.Tr.11-05-09©Dr Sylvain Chamberland
  55. 55. • Reassessment of bracket position Fr.Tr.17-08-09 • Pr: exo #75 & #85©Dr Sylvain Chamberland
  56. 56. • May 09 to Feb 10 • Torque of 12 and 22 has improved withFr.Tr.11-05-09 full dimensional 20 x Fr.Tr.09-02-10 25 SW • Delayed eruption of lower 2nd premolar extrend the treatment time©Dr Sylvain Chamberland
  57. 57. • Open eruption technique ! Full thickness palatal flap " Bonded button on canines A-A Gag 1104 " Closing + suturing the flap " Create opening through the flap A-A Gag 0505©Dr Sylvain Chamberland
  58. 58. A-A Gag 0505 A-A Gag 0605 A-A Gag 0805 A-A Gag 1105 A-A Gag 1106
  59. 59. A-A Gag 0805 A-A Gag 1105 A-A Gag 1105©Dr Sylvain Chamberland
  60. 60. Palatally displaced canine Ca-A.Bo.04-05 • Age: 20 y • Extraction 53, 63 • Closed eruption approach©Dr Sylvain Chamberland
  61. 61. Ca-A.Bo.08-07 Ca-A.Bo.10-07 • Bonded button + elastomeric chain • Correction of rotations 13 & 23 Ca-A.Bo.04-08©Dr Ca-A.Bo.11-07 Sylvain Chamberland Ca-A.Bo.01-08
  62. 62. Ca-A.Bo.08-07 Ca-A.Bo.10-07 Ca-A.Bo.11-07©Dr Sylvain Chamberland
  63. 63. Ca-A.Bo.11-07 Ca-A.Bo.01-08©Dr Sylvain Chamberland Ca-A.Bo.04-08
  64. 64. Ca-A.Bo.04-05 • Tx duration: 32 months Ca-A.Bo.11-08 Ca-A.Bo.08-10 21 months into retention©Dr Sylvain Chamberland
  65. 65. Transposed 23-22 Au.De. 17-11-08 Au.De. 12-01-09©Dr Sylvain Chamberland
  66. 66. Au.De. 12-01-09 • Severe ALD©Dr Sylvain Chamberland
  67. 67. Au.De. 30-06-09. •md: .016 sent med • #23 was pulled distally from the removable appliance • Removable appliance provide a good anchorage • Root movement of the lateral incisor by fixed appliances is avoided Au.De. 11-08-09. •md: .016 x.022 neost©Dr Sylvain Chamberland
  68. 68. Au.De. 30-06-09. •md: .016 sent med Au.De. 11-08-09. •md: .016 x.022 neost Au.De. 22-09-09.©Dr Sylvain Chamberland
  69. 69. Au.De. 17-11-08 • 8 months into treatment Au.De. 05-10-09. • From now: treatment is easy Au.De. 05-10-09. Mx: .016 SC ©Dr Sylvain Chamberland
  70. 70. Au.De. 19-12-06 Au.De. 23-02-09 • Easy, but it tooks times to get it done! 129 weeks Au.De. 15-08-11 ©Dr Sylvain Chamberland
  71. 71. 2006 Au.De. 17-11-08 2008 • Shes happy! Au.De. 15-08-11 2011©Dr Sylvain Chamberland
  72. 72. Pa.Be. 15-08-08 • Classe I • Impacted #13 • Severe ALD©Dr Sylvain Chamberland
  73. 73. • Retained #53 • Very heigh #13 • Impacted 8s Pa.Be. 15-08-08©Dr Sylvain Chamberland
  74. 74. • Bimaxillary protrusion • Tx plan !©Dr Sylvain Chamberland
  75. 75. At 54 weeks • #13 is erupting • Side effects are noted ! Cant of occlusal plane ! Intrusion of 12, 11 • Brackets and wires dont move teeth ! Forces and moments does©Dr Sylvain Chamberland
  76. 76. Pa.Be. 24-02-10 • Forced eruption was stopped from sept 09 to feb. 10 • Mx occlusal plane had to be leveled: 22 weeks ! Mx: .020 x .025 niti & .016 sent cantilever to distalize and extrude #13©Dr Sylvain Chamberland
  77. 77. Mx: .020 x .025 niti Md: .020 x .025 SS Pa.Be. 24-02-10 Pa.Be. 26-05-10 Pa.Be. 07-07-10 Pa.Be. 01-09-10 • Cantilever was effective to distallize and erupt #13 • Elastic ! was used to promote extrusion of the canine©Dr Sylvain Chamberland
  78. 78. Mx: .016 sent Pa.Be. 01-09-10 Md: .020 x .025 SS • Lower premolar are protracted with EC Mx: .020 x.020 neost Pa.Be. 06-10-10 Md: .021 x .021 x .020 x38 mm HDGW • Mx: .020 x .020 neost, EC 23-o-25-26-27 • Md: HDGW to protract molars; square anterior section including premolars is recommended©Dr Sylvain Chamberland
  79. 79. Pa.Be. 06-04-11 • Mx: .021 x .025 TMA (6 weeks) ! Does it slide? No! • Md: .021 x .025 SS from january 2011 to august 2011©Dr Sylvain Chamberland
  80. 80. Pa.Be. 22-08-11 • 154 weeks!! • Retrospectively, I would use a removable appliance and a cantilever spring to erupt #13. • It would have save me detrimental side effects and weeks of Tx©Dr Sylvain Chamberland
  81. 81. • Fairly good root parallelism Pa.Be. 22-08-11©Dr Sylvain Chamberland
  82. 82. ©Dr Sylvain Chamberland
  83. 83. • Shes happy©Dr Sylvain Chamberland
  84. 84. • Next©Dr Sylvain Chamberland

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