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CLINICIANS CORNER

Maxillary tooth transposition: Correct or accept?

Roberto Ciarlantinia and Birte Melsenb

Recanati, Italy, and Aarhus, Denmark

Among dentitional anomalies, tooth transposition is considered the most difficult to manage clinically.

Uncorrected, the results are often both functionally and esthetically unsatisfactory. Acceptance of the

malpositions and alignment is nevertheless the predominating treatment strategy in case reports in the

literature. Our aims in this article were to present a literature survey on the prevalence and the etiology and

to discuss the cost-benefit considerations influencing the treatment strategy and the decision whether to

accept or correct. An additional aim was to discuss the treatment of 12 patients who had maxillary

transpositions8 with maxillary canine and first premolar, and 4 with maxillary canine and lateral incisor9

of whom were corrected within normal treatment times.A segmented appliance allowed for the differentiation

between active and passive units of the appliance and for the delivery of a specific and necessary line of

action of the force. Two patients were treated with extractions, 1 because of periodontal problems and the

other because of crowding; in 1 patient, the transposition was accepted because the alignment had been

started by another dentist. (Am J Orthod Dentofacial Orthop 2007;132:385-94)

The prevalence of tooth transposition has been

described based on epidemiologic studies of

various populations. In a sample of 800 Scottish

orthodontic patients, transposition was found in 0.38%.1

This was similar to the figure of 0.4% reported for a

population in India studied by Chattopadhyay and Srini-

vas.2 In another study, Yilmaz et al3 also found that

0.38% of a Turkish population had tooth transposition.

Among 384 Swedish school children, the prevalence

was reported to be 0.26% by Thilander and Jacobsson,4

whereas Ruprecht et al5 found transposition in only

0.13% of Saudi Arabian dental patients. A higher

prevalence, 0.51%, was reported in an African popula-

tion comprising contemporary subjects and skeletons

from 100 BC and AD 1350.6 In a study of Native

Americans, 1.8% had transposed maxillary canine and

first premolar (Mx.C.P1).7

Transpositions can, according to some authors,3,8

affect both sexes equally, whereas others reported that

they are more frequent in females,9-12 and some even

found the prevalence higher among males.2,13 Although

transposition can appear in both the maxilla and the

mandible, the Mx.C.P1 transposition is the most fre-

quently described, followed by transposition of the max-

illary lateral incisor with the canine (Mx.C.I2).8,11,14Peck

and Peck11 collected 201 published cases of maxillary

transpositions and found that 71% could be classified as

Mx.C.P1 and 20% as Mx.C.I2.

Unilateral transpositions are found more often than

bilateral transpositions, and the left side is more fre-

quently involved than the right.15,16 In the mandible,

transposition is reported to involve the canine and

incisors only.17,18 Transpositions have, to our knowl-

edge, not been reported in the deciduous dentition.

Mx.C.P1 transposition is always a result of dis-placement and ectopic eruption of the maxillary canine,

but a genetic influence on its development has been

supported by the elevated frequencies of associated

dental anomalies, such as incisor impaction; absence of

at least 1 permanent tooth; missing, small (Fig 1,B). or

peg-shaped (Fig 1,J) maxillary lateral incisors; in-

creased incidence of bilateral occurrence in families;

and significant differences between male and female

prevalence.2,10,16,19-25 Mx.C.I2 transposition is, on the

other hand, frequently caused by trauma to the decid-

uous dentition resulting in drift of the permanent tooth

bud.11

However, genetic influence on Mx.C.I2 transpo-sition cannot be totally excluded.11 Local pathologic

processes, such as tumors (Fig 1, F and I) and cysts,

retained deciduous canines, lack of deciduous canine

root resorption, and supernumerary teeth (Fig 1,E)

might also be responsible for the displacement of a

canine, causing deflection lingually or labially or, if

mesially displaced, transposition with the lateral incisor

or, if distally displaced, transposition with the first

premolar.15

Clinical management of transposed teeth comprises

the following treatment options.26

aPrivate practice, Recanati, Italy.bProfessor and head, Department of Orthodontics, University of Aarhus,

Aarhus, Denmark.

Reprint requests to: Birte Melsen, Department of Orthodontics, University of

Aarhus, Vennelyst Boulevard 9, DK-8000 Aarhus C, Denmark; e-mail,

[email protected].

Submitted, April 2005; revised and accepted, April 2007.

0889-5406/$32.00

Copyright 2007 by the American Association of Orthodontists.

doi:10.1016/j.ajodo.2007.04.011

385


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Fig 1. Pretreatment and posttreatment radiographs of 12 patients treated for transposition. Patients

are listed by letter; images labeled 1 are pretreatment, and those labeled 2 are posttreatment.

American Journal of Orthodontics and Dentofacial Orthopedics

September 2007

386 Ciarlantini and Melsen


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1. Interceptive treatment: if detected early enough, at

the age of 6 to 8 years, extraction of deciduous

teeth, guiding the eruption of the transposed tooth

into the normal position, while the space is main-

tained by a lingual arch or a palatal bar. Usually,this approach is possible only if the teeth are tilted

so that the roots are near the desired position; this

clinical situation is also called pseudotransposition.

2. Alignment of teeth in their transposed positions

followed by reshaping their incisal or occlusal

surfaces and using composite materials for restor-

ative camouflage.

3. Extraction of 1 or both transposed teeth followed by

orthodontic correction. This strategy has been rec-

ommended when other factors such as crowding

and caries indicate extraction.

4. Orthodontic tooth movement to the correct intra-arch position.16

Among the Mx.C.P1 and Mx.C.I2 cases described

in the literature (Table I), the choice of treatment has

often been 2 or 3, because the correction was consid-

ered both difficult and long.8,11,13,16,22,23,27-44 Treat-

ment times ranged from 18 to 49 months.

Several factors should be considered when making

the treatment plan.

1. Dental morphology. The dental morphology is of

the utmost importance when a transposition must be

maintained, because reshaping the teeth is neces-sary for an illusion of correct position.

2. Occlusal considerations. The underlying malocclu-

sion, morphological and functional, and the possi-

bility of obtaining a symmetrical canine-guided

group function influence the choice of treatment.26

If substituting the canine with the first premolar is

considered, the roots of the maxillary first premolar

must have morphology that allows for the necessary

rotation without generating fenestrations corre-

sponding to the buccal root.

3. Facial esthetics. Facial prognathism is also impor-

tant when extraction is considered an alternative.4. Stage of development and position of the root

apices. The buccolingual width of the alveolar bone

is often not sufficient to support 2 adjacent teeth

moving in different directions, especially when

they are fully erupted. Compression and friction

during correction can cause iatrogenic damage to

teeth (eg, root resorption) and periodontal tissues

(eg, clefting and recession of gingival tissue).

5. Treatment time. Treatment time for either correc-

tion or acceptance must be considered from a

cost-benefit point of view.26

The literature on transposition is more focused on

epidemiology. Treatment is dealt with mainly in reports

of 1 case or a few cases in addition to a review of the

latter.

Our purposes were to demonstrate the treatment of12 patients with maxillary transposition and to present

the rationale behind the treatment approach.

MATERIAL AND METHODS

All patients included in this report had transposi-

tions in the maxilla, 8 with Mx.C.P1 and 4 with

Mx.C.I2 (Fig 1).

The patients ages ranged from 10 years 2 months

to 14 years, except for one who was 52 years old. There

was equal distribution between the right and left sides,

and, in 9 patients, the canine was vestibular to the other

teeth. All patients had a Class I molar relationship

except 2 with a Class II subdivision. Treatment times

varied from 12 to 30 months, with an average of 19

months (Table II). All patients received a fixed retainer

except 2 in whom a removable Hawley retainer was

used (Fig 1,A and I).

RESULTS

Correction was attempted in 9 patients. Full correc-

tion with no crossover of the roots was obtained in 7

patients (Fig 1). Correction of the transposition but

without complete root paralleling was seen in 2 patients

(Fig 1,B andD). In 3 patients, a different approach was

chosen (Table II). Alignment of the teeth in the trans-posed position was chosen for the patient inFigure 1,F.

That patient had been treated by another orthodontist

for a long time, and the canines were almost aligned.

Esthetically, it was acceptable because there was great

similarity between the buccal morphology of the canine

and the premolar. Functionally, it was possible to

obtain group function after grinding the lingual cusp of

the premolar. A premolar was extracted in the adult

patient in Figure 1,H, for periodontal reasons. The

canine was localized lingually to the premolar, and

there was a deep pocket between the vestibular side of

the maxillary canine and the palatal side of the firstpremolar. This could not be treated because it would be

impossible for the patient to maintain good hygiene and

a healthy periodontium between these 2 adjacent teeth

during orthodontic treatment. It was decided to extract

the periodontically affected premolar, which was later

replaced by prosthodontic treatment. In patient L, with

Mx.C.I2 transposition with a Class II molar relationship

on the left side, the involved lateral incisor was ex-

tracted. The roots of the involved teeth were already

almost completely aligned in the transposed order.

Correction of the transposition would be a long treat-


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Ciarlantini and Melsen 387


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Table I. Survey of literature on transposition

Author Year n

Age

(y, mo) Type

Right, left,

bilateral

Vestibular,

palatal

Treatment time

(mo)

Treatment

option Comments

Maxillary transpositions

Payne23 1969 1 11, 9 MxCP1 R V 33 Transposition1 MxCP1 B V 16 Transposition

Newman22 1977 1 MxCP1 R Interceptive All relatives

1 MxCP1 R V Transposition

1 MxCP1 L V Transposition

1 MxCP1 L V Transposition

1 MxCP1 R V Prosthetics

Shapira et al45 1980 2 MxCP1 L 5 alignment

4 MxCP1 R 3 extractions

1 MxCI2 L 1 tranplantation

2 MxCI2 R Correction

Laptook and Silling33 1983 1 12 MxCP1 B V 1 correction, 1

alignment

1 15 MxCI2 L V Correction Pseudotransposition

Shapira et al

8

1989 1 17 MxCP1 B V Transposition1 11, 5 MxCP1 R V Transposition

1 13 MxCP1 R V Extraction

Shapira et al41 1989 1 12, 5 MxCI2 R V 36 Correction

Bassigny27 1990 1 MxCI2 R V Correction

1 MxCP1 R V Extraction

Pajoni and Saade36 1990 1 11, 5 MxCP1 L V 30 Extraction

1 12, 5 MxCP1 L V 18 Transposition

Parker37 1990 1 13 MxCP1 B V 20 Transposition

Shanmuhasuntharam

and Thong401990 1 20 MxCM1 L V Extraction

Lanteri et al32 1991 1 13 MxCP1 L Transposition

1 12 MxCP1 L V Transposition

1 13 MxCP1 L V Transposition

Zuccati44 1994 1 27 MxCI2 B P Correction Pseudotransposition

Peck and Peck11 1995 1 12, 5 MxCP1 B V 24 Transposition1 11, 3 MxCP1 R V Extraction

1 11, 5 MxCP1 R V Correction failed

1 12, 2 MxCP1 L V 35 Interceptive

Wasserstein et al43 1997 1 12, 5 MxCI2 L P 26 Correction

Rabie and Wong38 1999 1 13 MxCI1 B V Extraction

Swinnen et al42 1999 1 8, 3 MxCI2 L P 29 Extraction

Maia34 2000 1 10, 10 MxCI2 L V 49 Extraction

Laino et al30 2001 1 10 MxCP1 R V 32 Correction

Miyawaki et al35 2001 1 10 MxCI2 L V 25 Transposition

Shapira and Kuftinec16 2001 1 12 MxCI2 R V 45 Correction

Bocchieri and Braga28 2002 1 10, 7 MxCP1 B V 34 Correction

Demir et al29 2002 1 22 MxCP1 R V 20 Transposition

Langlade31 2002 1 10 MxCP1 B V Correction

1 12 MxCP1 R V Correction

Sato et al39 2002 1 12 MxCP1 B V Extraction

Mandibular

transpositions

Shapira et al46 1978 1 11 MdCI2 B V Transposition

Shapira et al45 1980 2 MdCI2 B Transposition

Shapira et al47 1982 2 8-13 MdCI2 B 5 interceptive

4 MdCI2 R 1 extraction

1 MdCI2 L 1 alignment

Laptook and Silling33 1983 1 12 MdCI2 L V Correction

Lieberman et al48 1983 1 10 y MdCI2 R Interceptive

Shapira et al49 1983 2 12-15 MdCI2 R V Extraction

2 MdCI2 B V Transposition

1 MdCI2 L V Transposition


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ment without predictable success because of the

crowded maxillary incisors. The fact that the crown of

the canine was small and easy to reshape as a lateral

also supported this treatment option. The treatment

approach was thereafter the same as for patients with

agenesis of 1 lateral incisor.

In the remaining 9 patients, the transposition was

corrected by goal-oriented mechanics, in which the

appliance was activated to generate the desirable line ofaction of the force with respect to the transposed teeth.

This could be executed only by using segmented

appliances that allow for the differentiation between the

active and the passive units. The passive unit was

consolidated by a transpalatal arch. The active part of

the appliance was a segment with a configuration that

allowed for the generation of the correct line of action

of the force in all 3 planes of space. The appliances

used to correct the 2 types of transposition are

illustrated in the examples of Mx.C.P1 and Mx.C.I2

below.

Case report, patient A: Mx.C.P1 and treatment

option 4

A girl, aged 11.1 years, had a canine buccally

transposed between teeth 14 and 15 (Table II;Figs 1,A,

and2). Her maxillary deciduous right canine was still

not mobile, and the left one had been shed a long time

ago. Clinical examination showed a convex profile. The

upper dental midline was shifted 1 mm to the right, andthe patient had a Class I molar relationship on both

sides. There was mild crowding in the mandibular arch.

The intraoral radiographs showed that the apex of the

maxillary right canine was vestibular and distal to the

first premolar. The first premolar was distally tipped

and the apex was in the canine region (Fig 1,A1). No

local factors could account for the transposition of the

canine. Correction of the transposition was chosen as

the treatment objective, because the canine was not yet

fully erupted and the apices of the 2 transposed teeth

were not close; thus, the risk of root resorption was

Table I. continued

Author Year n

Age

(y, mo) Type

Right,

left,

bilateral

Vestibular,

palatal

Treatment time

(mo)

Treatment

option Comments

Shapira et al8 1989 1 14 MdCI2 L V Transposition1 11 MdCI2 R V Extraction

Yaillen50 1989 1 8, 8 MdCI2 R V 28 Interceptive

Bassigny27 1990 1 MdCI2 L Interceptive

1 MdCI2 R V Interceptive

1 MdCI2 L V Interceptive Periodontal graft

Pajoni and Saade36 1990 1 9 MdCI2 L 48 Extraction

Parker et al37 1990 1 10, 1 MdCI2 L V 22 Interceptive

1 14, 9 MdCI2 L V 20 Transposition

Brezniak et al51 1993 1 19 MdCI2 V Transposition Periodontal graft

MdC12, mandibular transposition between canine and lateral incisor.

Table II. Survey of patients treated

Patient Sex

Age

(y, mo) Type

Right, left,

bilateral

Vestibular,

palatal

Treatment time

(mo)

Treatment

option Comments

A F 11, 1 MxCP1 R V 18 Correction Case report 1

B F 11, 4 MxCP1 R V 16 Correction

C F 12, 4 MxCP1 L V 26 Correction

D F 10, 5 MxCP1 R V 16 Correction

E M 11, 7 MxCP1 L P 20 Correction

F M 14 MxCP1 B V 20 Alignment

G M 11, 5 MxCP1 R V 22 Correction

H M 52 MxCP1 R P 12 Extraction

I F 11, 8 MxCI2 L V 26 Correction Case report 2

J F 10, 11 MxCI2 R P 20 Correction

K M 13, 10 MxCI2 L V 30 Correction

L M 10, 2 MxCI2 L V 26 Extraction

F, Female; M, male.


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considered limited (Fig 2,A and B). An alternativewould have been to let the canine erupt distal to the

premolar. This would, considering the morphology of

the crowns of both teeth, have been both esthetically

and periodontally unsatisfactory. Extraction was not

considered because the patient had a Class I molar

relationship on both sides.

Treatment started with placement of a transpalatal

arch for maximum anchorage and 2 individually con-

figured rectangular loops of 0.017 0.025-in beta-

titanium alloy as the active unit. Both loops extended

from the double tube on the molar band. One loop was

first placed to displace the canine mesially, keeping thevertical level (Fig 2, C). Once this movement had

started, the second loop was placed to upright the

premolar simultaneously with the continued mesial

movement of the canine (Fig 2,D). After sagittal

correction that lasted for 8 months, the loop used for

mesial displacement was activated for eruption and

lingual movement of the canine (Fig 2,Eand F). At the

end of treatment, a 0.017 0.025-in nickel-titanium

wire was placed for minor finishing (Fig 2,G and H).

The fixed appliances were removed after 18 months

(Fig 2,I). The intraoral radiographs confirmed the

Fig 2. Patient A. A, Pretreatment intraoral photograph. B, Rectangular loop for buccal and forward

displacement of canine. Vertical level of canine was maintained while sagittal correction was

performed. C, Schematic of cantilever and force system. D, Treatment progress after 8 months.

Sagittal displacement of canine has been performed, and eruption can begin while uprighting of

premolar root continues. E, Schematic of appliance used for eruption of canine and uprighting of

premolar root. F, After 12 months of treatment. G and H, Finishing after 16 months of treatment.

I, Posttreatment intraoral photograph. JM, X-ray series from pretreatment to posttreatment.


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correction (Fig 2,J-M). A Hawley retainer was used in

the maxillary arch for retention. A posttreatment radio-

graph (Fig 1,A2) indicated that the canine root was not

correctly inclined, this was probably due to the ineffi-

ciency of the removable retainer, since the photo taken3 months earlier (Fig 2,M) showed satisfactory root

position and no root or periodontal damage.

Case report, patient I: Mx.C.I2 and treatment

option 4

A girl, aged 11.8 years, had a maxillary left canine

transposed between the central and lateral incisors

(Table II;Figs 1,I, and 3). She had lost her maxillary

left deciduous canine several months previously, and

her mother was concerned because the canine did not

erupt. The clinical examination showed a 2-mm mid-

line shift to the left of the maxillary arch, a Class II

molar relationship on the right side, and a Class I molar

relationship on the left. The intraoral x-rays showed

transposition with the maxillary left canine erupting

between the lateral and central incisors (Fig 1,I). A

possible etiology in this patient could be an odontoma

in the region of tooth 22 that had been surgically

removed at the age of 7 years. At the same time, a

frenulectomy had been performed. Correction was

chosen as the treatment goal, because the canine had

favorable inclination, and this would facilitate correc-

tion of the midline.

As an alternative, extraction of the lateral incisor

and maintenance of the distal molar relationship couldhave been done. This would, however, have led to an

esthetic compromise, because the morphology and the

dimension of the canine were not similar to the lateral

incisor. Extraction of the canine was a high price for the

patient and would have called for mesial displacement

of all posterior teeth of that side, with no shortening of

the treatment time.

Treatment started with placement of a transpalatal

arch activated in the first order for distal movement of

tooth 16. Class II traction was applied on the other side

to counteract mesial movement of tooth 26 as a side

effect of the asymmetrical activation of the transpalatalarch. After 8 months, the molar relationship was

corrected and the transposed canine was surgically

exposed, and a 0.016 0.022-in beta-titanium alloy

archwire extending from tooth 16 across the midline to

the transposed canine was placed. The wire was placed

into the brackets of all teeth from 16 to 21, bypassing

tooth 22, and ending in an extension apically in the

canine region. During the first phase of treatment, a

power arm was added to the exposed canine, and the

first activation was to displace the canine distally while

maintaining the vertical level with a force passing close

to the center of resistance (Fig 3,C). During the next

phase, the power arm was removed, and the extension

was shortened and activated for vestibular movement of

the canine (Fig 3, B and D). The appliance was

constructed so that the distal displacement of the caninewas counteracted by midline correction (Fig 3,A).

After 18 months of treatment, the canine had passed

above the lateral incisor and was brought down to the

level of the dental arch. The distal movement was

continued with a 100-cN nickel-titanium coil spring,

and a cantilever made of 0.016 0.022-in beta-

titanium alloy was used for uprighting and rotation of

the lateral incisor (Fig 3,E and F). In relation to the

next phase of treatment, buccal root torque was added

to the lateral incisor. This was done with a wire placed

into the bracket of the lateral only and tied to a heavy

stainless steel wire extending from molar to molar (Fig

3,G andH). Simultaneously, the mandibular arch was

levelled, and the mandibular canine was slightly in-

truded to improve the canine guidance. During the

finishing phase, a torque arch was applied to generate

buccal root torque to the maxillary incisors, and an

0.018-in beta-titanium alloy round wire welded to a

0.017 0.025-in beta-titanium alloy arch and activated

90 was applied to obtain palatal root torque on the

maxillary left canine (Fig 3,I). At the end of treatment,

a continuous arch was applied for the generation of

second- and third-order correction of tooth 22. The

fixed appliance was removed after 26 months, and a

removable Hawley retainer was used for retention.All treatment objectives were obtained. No root

resorption was found on the final radiographs, the

inclinations of the roots were corrected (Fig 1,I2), and

the level of attached gingiva of teeth 22 and 23 was

maintained. Esthetically, the result was optimal (Fig 3,

Jand K). The duration of the treatment was within the

normal range.

DISCUSSION

In this article, we report on the treatment of 12

consecutive patients with transposition in the maxilla.

The radiographic images are shown in Figure 1. Itappears that all patients, except patient K, had total

transposition, and that patients I and J had favorable

root inclination. In 9 patients, correction was per-

formed. Based on the literature, the treatment approach

most frequently recommended has been acceptance or

extraction of 1 tooth involved in the transposition

(Table I). Correction was considered impossible by

some authors. Sandham and Harvie1stated that correc-

tion of transposition at a later stage would be impossi-

ble orthodontically, and tooth sequence must be ac-

cepted. Peck and Peck11also suggested correcting only


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pseudotranspositions and maintaining the transposed

tooth order in all types of true transposition. They

indicated that attempts to restore the natural tooth order

would usually lead to prolonged orthodontic treatment

with less than adequate results due to the difficulties of

root movement. Weeks and Power26also discussed the

drawbacks related to correction and described the

interventions necessary to obtain an acceptable com-

promise without correction of the transposition. Cor-

rection of the teeth to their normal position was

reported by some authors,28,30,31,33 all of whom used

segmented or partially segmented appliances and took

Fig 3. Patient I. A and B, Intraoral photographs at start of treatment. C and D, Appliance design. At

first stage (C), cantilever was tied to power arm in canine bracket; force was close to center of

resistance. In second stage (D), power arm was removed, and cantilever was applied for buccal and

distal displacement of canine. E and F, Cantilever applied for rotation and uprighting of lateral

incisor. G and H, Torque arch delivering buccal torque to lateral incisor. I, Torque arch deliveringbuccal torque to maxillary front teeth and bypassing canine. Lingual root torque was delivered

simultaneously to canine by beta-titanium alloy arch to which perpendicular extension was welded.

Extension was placed in vertical tube of canine and activated 90 by placing main arch into auxiliary

molar tubes. J and K, Posttreatment photographs (radiographs shown in Fig 1,I).


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great care to avoid contact between the teeth when the

passage was performed. Shapira and Kuftinec8 stated

that the correction is complex and can be damaging to

both the teeth and the supporting structures, and pre-

sented the pros and cons of both alignment and correc-tion.

The long distance the roots must be displaced might

be a risk for root resorption. Among the patients treated

in this report, the radiographs of patients B, F, J, and K

exhibited significant root shortening. In B and F,

pronounced root resorption was seen on the first pre-

molar. However, the pretreatment images showed that

this was already present at the start of treatment. One of

the 2 premolars (patient F) had 2 roots for which reason

the performed treatment would still be the preferred

approach because it would be difficult to have this

premolar mimic a canine. In patient J, the morphology

of both teethcone shapemight predict an increased

risk of resorption. The resorption in neither patient J

nor patient K could be considered crucial for the

long-term prognosis of these teeth (Fig 1).

Apart from patient H, who had periodontal disease,

none of the patients had periodontal damage after

treatment.

Correction requires tooth displacements that are

fully controlled in 3 planes of space. It has been

suggested to start treatment with palatal displacement

of the premolar or the incisor before moving the canine

into its normal position. The treatment would be fin-

ished with buccal movement of the palatally displacedteeth.31 In these patients, an attempt was made to

correct the mesiodistal discrepancy while the canine

was still in a high position and not fully erupted so that

the eruption could be guided after the mesiodistal

correction. Only segmented appliances allow the appli-

cation of well-defined and frictionless biomechanical

force systems for highly controlled tooth movement;

cantilevers and various types of loops can be designed

according to the laws of equilibrium. The results are

highly predictable, and undesirable side effects (round-

tripping, iatrogenic damage) can be minimized and

easily monitored.30 The low load-deflection rate andwide range of activation of nickel-titanium springs and

beta-titanium alloy wires enable them to maintain high

constancy of both force and moments during orthodon-

tic therapy without the need for frequent reactivations

and appliance adjustments. This treatment strategy

resulted in clinically satisfactory corrections when this

was attempted, and the treatment results were obtained

within the time frame of normal orthodontic treatment.

However, in the treatment results on the intraoral

radiographs (Fig 1), it can be seen that, in patients A, B,

and D, total paralleling of the roots was not obtained. In

patient A, it seemed that there had been relapse because

the x-ray taken at appliance removal showed parallel

roots. The Hawley retainer was obviously unable to

maintain the result. In patient B, the root resorption

seemed to be active, and the treatment was finishedwhen the clinical result was satisfactory. Patient D had

a hygiene problem during treatment, and considering

the caries risk, finishing was recommended when the

clinical result was acceptable.

CONCLUSIONS

Corrections of total transpositions of M.C.P1 and

Mx.C.12 with appliances especially designed to deliver

the correct force system were demonstrated. The treat-

ments were carried out within a normal time frame, but

costs in terms of root shortening were observed in 2

patients; in 2 others, paralleling of the roots was

unsatisfactory after treatment. Although we demon-

strated that transposed teeth can be brought into their

correct positions, it was advantageous to treat the

patients when the canine was still not fully erupted.

When the teeth involved in the transposition are fully

erupted and completely or almost completely aligned in

the transposed position, a satisfactory result can be

obtained by maintaining the transposition, and correc-

tion, even if possible, would not always be advisable

from a cost-benefit point of view.

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3. Yilmaz H, Turkkahraman H, Sayin M. Prevalence of tooth

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4. Thilander B, Jakobsson SO. Local factors in impaction of

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5. Ruprecht A, Batniji S, El-Neweihi E. The incidence of transpo-

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