{"id":22296,"date":"2013-07-03T00:00:00","date_gmt":"2013-07-03T00:00:00","guid":{"rendered":"https:\/\/sylvainchamberland.com\/classe-ii-division-2-impaction-canine-posterior-crossbite\/"},"modified":"2023-08-21T14:15:15","modified_gmt":"2023-08-21T14:15:15","slug":"classe-ii-division-2-impaction-canine-posterior-crossbite","status":"publish","type":"post","link":"https:\/\/www.sylvainchamberland.com\/en\/classe-ii-division-2-impaction-canine-posterior-crossbite\/","title":{"rendered":"Class II division 2"},"content":{"rendered":"

Click on the orange title to see the complete case.<\/strong><\/p>\n

Here is a Class II division 2 case. We observe a backward shift of the lower dentition (red arrows). On the right, we observe a posterior crossbite of the first molars<\/strong> (green circle). The disposition of the 4 upper incisors is typical<\/strong> and pathognomonic<\/strong> of a Class II division 2<\/strong>. In addition, the upper left canine<\/strong> is not only impacted<\/strong>, but also transposed<\/strong> between the central and lateral incisors (blue circle<\/strong>). Normally, the canine is located between the lateral incisor and the first premolar.<\/p>\n

\"\"

Class II division 2<\/p><\/div>\n

\"\"

Impaction and transposition of the upper left canine (blue circle)<\/p><\/div>\n

The panogram shows well the transposition of the canine (blue circle)<\/strong> between the central and lateral incisors. Note that the root of the primary canine shows no resorption<\/strong> compared to the right primary canine where we only see the crown and the root of the primary tooth is no longer present.<\/p>\n

Sequence of treatment<\/h3>\n

\u2022 Maxilla:<\/p>\n

\u2022 Rapid palatal expansion<\/strong> and distalization of the first molars (backward movement)<\/p>\n

\u2022 Surgical ligature of the impacted canine<\/strong><\/p>\n

\u2022 Bonding of SPEED\u2122 brackets<\/p>\n

\u2022 Alignment of the maxillary dental arch<\/p>\n

\u2022 Traction of the canine<\/strong><\/p>\n

\u2022 Correction of the transposition<\/strong><\/p>\n

\u2022 Alignment of the left lateral incisor<\/p>\n

\u2022 Finishing<\/p>\n

\u2022 Removal of fixed appliances (brackets)<\/p>\n

\u2022 Retention<\/p>\n

\u2022 Mandible:<\/p>\n

\u2022 Bonding of SPEED\u2122 brackets<\/p>\n

\u2022 Alignment and preparation on right arch<\/p>\n

\u2022 Correction of the sagittal (anteroposterior) relationship with intermaxillary elastics<\/p>\n

\u2022 Finishing<\/p>\n

\u2022 Removal of fixed appliances (brackets)<\/p>\n

\u2022 Retention<\/p>\n

Evolution of orthodontic treatment<\/h3>\n
\"\"

Evolution after 18 months of treatment<\/p><\/div>\n

\"\"

Expansion appliance on panoramic X-ray<\/p><\/div>\n

After 18 months<\/strong> of treatment, the relationship in width<\/strong> of the upper maxilla with the mandible became normal<\/strong> because of the palatal expansion<\/strong>. The sagittal<\/strong> (front-back) relationship<\/strong> is normal<\/strong> (fit of red arrows on the image on the left) because the posterior teeth moved back<\/strong> during the palatal expansion with a Pendulum<\/a> appliance<\/strong>.<\/p>\n

On the X-ray<\/strong>, we can identify the expansion screw<\/strong>, the supports bonded to the premolars, the springs<\/strong> which moved back the molars and the space<\/strong> that was created.<\/p>\n

Intermaxillary elastics<\/strong> are used to maintain the sagittal correction.<\/p>\n

The upper left canine is visible through the mucosa<\/strong>. It goes over<\/strong> the lateral incisor on which a bracket was not bonded. It is important to let the lateral incisor move freely toward the palate while the canine jumps over it. There is an important risk to cause root resorption<\/strong> of the lateral incisor by the pressure that the canine crown puts on the tooth while it moves above the root. Sequential X-rays<\/strong> were taken to monitor the situation. The traction vector<\/strong> of the impacted canine was lateral<\/strong>, that is outward first until the root of the lateral incisor was no longer in danger. Afterwards, we started the vertical movements. The cantilever armspring<\/strong> is made of a superelastic nickel-titanium alloy. GAC Dentsply<\/strong> is the supplier. The product code is Sentalloy rotating spring<\/strong> #10-003-01, 02, 03, 04. See another example of cantilever on the page impacted canine\/mechanotherapy<\/a>.<\/p>\n

When the canine was visible in the mouth<\/strong>, we had to proceed with the alignment of the lateral incisor<\/strong> and the straightening up of the canine<\/strong>. There were only 2 teeth to move, but the amplitude of movement<\/strong> required to have each of these teeth aligned correctly was considerable<\/strong>. In two words, it took time.<\/p>\n

Final result<\/h3>\n
\"\"

Final occlusion 6 weeks after the brackets were removed<\/p><\/div>\n

.<\/h4>\n

Here is the result obtained at the end of the orthodontic treatment which will have lasted 3 years. The determining factor in the duration of treatment was the correction of the canine-lateral incisor transposition<\/strong>. This added up<\/strong> to the other problems already enumerated:<\/p>\n

\u2022 Problem with the width of the palate (crossbite).<\/p>\n

\u2022 Backward shift problem of the lower dentition (mandibular retrognathia).<\/p>\n

\u2022 Problem with an impacted canine.<\/p>\n

Remodeling of the gingiva on the upper canine and the lateral incisor on the left side will continue. The patient was advised to clean this area well with the toothbrush and dental floss. For that matter, you can notice a light gingival bleeding caused by bacterial plaque accumulation due to inadequate maintenance.<\/p>\n

Final panoramic X-ray<\/h3>\n
\"\"

Final panoramic X-ray of the Class II division 2 case<\/p><\/div>\n

The panoramic X-ray shows a good root parallelism<\/strong> (the teeth are distributed in parallel from one another). Resorption of the root of the lateral incisor<\/strong> can be seen and can be explained by the perilous jumps that were done between the canine and the lateral incisor.<\/p>\n

The septal bone between the canine and the lateral incisor seems absent. This can be explained by the proximity of the canine crown against the root of the lateral incisor during the treatment. Never having enough space during the treatment, the septal bone could not develop. We will have to re-evaluate in 6 months after the remodeling of the alveolar bone, consecutive to an orthodontic treatment, will have occurred. The fate of the third molars will have to be re-evaluated in a couple of years.<\/p>\n

Initial and final cephalometric X-rays<\/h3>\n
\"\"

Initial and final cephalograms<\/p><\/div>\n

The impacted canine is indicated by the red arrows on the initial cephalogram.<\/p>\n

The final cephalogram<\/strong> shows the completed correction<\/strong> and an adequate relationship between the upper and lower incisors<\/strong>.<\/p>\n

The relationship between the lips and the nose-chin tangent stayed similar.<\/p>\n","protected":false},"excerpt":{"rendered":"

Click on the orange title to see the complete case. Here is a Class II division 2 case. We observe a backward shift of the lower dentition (red arrows). On the right, we observe a posterior crossbite of the first molars (green circle). The disposition of the 4 upper incisors is typical and pathognomonic of […]<\/p>\n","protected":false},"author":2,"featured_media":23156,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[745,413],"tags":[],"class_list":["post-22296","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-class-ii-division-2-treated-cases","category-treated-cases"],"acf":[],"yoast_head":"\nClass II division 2 - Dr. Sylvain Chamberland, Orthodontist<\/title>\n<meta name=\"description\" content=\"Understanding Class II Division 2: Learn about this specific classification of malocclusion and its treatment options for achieving a well-aligned smile.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.sylvainchamberland.com\/en\/classe-ii-division-2-impaction-canine-posterior-crossbite\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Class II division 2 - 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