Canine included in vestibular position
The upper canines are included buccal to the roots of the lateral incisors, which explains their labial tilt.
1-1st stage of treatment: extraction of the primary canines, correction of the cross-articulation of the upper central incisors and palatal expansion.
2-2nd stage: surgical ligation of the canines and distal traction as indicated by the arrows on the central radiograph. The elastics were hooked onto the spring loops welded to the Adams hooks. The elastics engaged in the ligature loops.
3- Note that on the 3rd radiograph, the crowns of the canines are no longer opposite the roots of the laterals.
The photo on the far right shows how the cantilever springs engaged with the traction loops to apply a vertical egression force.