Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 40

Case Report

the entire surface of each exposed canine
to prevent the tissue from growing over. As
the tissue healed, the surgeon attempted to
place Kaplan hooks on the canines; however, the angulation of the placement of the
hooks was not desirable, as the elastics kept
slipping off. The treating orthodontist had to
reposition the Kaplan hooks in the 4-o'clock
position on the lingual side of maxillary
right canines (UR3) and at the 8-o'clock position for the maxillary left canine (UL3). Clear
and metal lingual buttons were also placed
on the L4s and L5s, respectively. Heavy Class
II elastics (3/16-in, 6 oz) were placed onto the
Kaplan hooks on the U3s and to the buttons
on the L5s to bring the crowns of the U3s
distally and to pull the U3s away from the
roots of the maxillary incisors (Figure 4).
Once these crowns were tipped back and
positioned at the proper anteroposterior
locations, triangle elastics were attached
to the Kaplan hooks on the U3s and to the
buttons on L4s and L5s. The patient wore
heavy elastics (3/16 in, 6 oz) to bring the U3s
labially.
Once more of the labial surfaces of both
maxillary canines were observed, both
dental arches were scanned for the first refinement aligners. The objectives of this refinement were to level and align the arches,
bring the canines into an ideal position, and
correct the bite to a Class I dental relationship. Lingual attachments were added to
U3s to facilitate pushing them more labially
and occlusally, as their labial crown heights
were short (Figures 5 and 6). A total of 32
refinement aligners were planned in this
first refinement. A second refinement with
22 sets of aligners was prescribed to sock in
the bite and rotate the canines to an ideal
position. All aligners were changed weekly.
Throughout treatment, the bite turbos bonded on the U1s prevented the posterior teeth
from touching, thus allowing them to erupt.
As a result, these bite turbos helped to open
the deep overbite and level the curve of Spee.
Moreover, the bite turbos also helped intrude

40	

Figure 5. Progress intraoral photographs (six months after exposure; the intraoral scan was
sent for the first refinement)

Figure 6. Progress intraoral photographs (10 months after exposure)

Figure 7. Progress intraoral photographs (21 months after exposure, three months before
debonding)

PCSO Bulletin    Spring 2021



Pacific Coast Society of Orthodontists Bulletin Spring 2021

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