Impacted Canines brought in without braces

Measurements

Treatment

Objectives. Provide an esthetic, braces-free treatment option using Invisalign with auxiliaries to bring the impacted canines into the arch while using tray pontics to maintain appearance and avoid visible gaps during treatment

Plan. Begin Invisalign treatment with bonded attachments and bite turbos on the maxillary central incisors. Use the initial aligners to open adequate space for the impacted canine while maintaining esthetics with a tray pontic. Once adequate space is created, extract the retained primary canine, surgically expose and bond the impacted canine, and attach a traction arm. Scan and order additional aligners with a pontic, then tie the upper right canine to the aligner loop to begin traction into the arch. As the canine erupts, bond a button and use elastics as needed to guide it into position. Once the canine has erupted sufficiently to scan, rescan and incorporate it into the Invisalign treatment plan for final alignment with the aligners.

Appliances and materials

• Invisalign — with bonded bite turbos
• use 030 wire to make a bonded arm to bring in canine — Tie in with elastic thread

Progress records

Bonded metal arm and tie canine in after exposure

Tie in canine. Able to wear alginers and pontic present

Start intraoral elastics

Scan to order refinements once canine is in enough to scan

Outcome

Brought both canines in and finished with Class I molars and canines. Did not need braces.

Retention

• Fixed U2-2 permanent retainer
• Fixed 3-3 retainer with pontic
• Invisalign Vivera retainers to be worn at night

Upper Retainer has Bite ramps to help maintain bite opening