Transmigrated mandibular canines increase treatment complexity in terms of both anchorage and biomechanical planning, posing challenges for both Orthodontists and Oral Surgeons. This case report presents the orthodontic treatment in a 12-year-old girl patient, with transmigrated and impacted mandibular right canine positioned horizontally below the apices of the mandibular incisors. The mandibular deciduous right canine was extracted followed by the traction of the transmigrated permanent canine. Eruption was properly guided, and the correct position of the tooth was orthodontically guided into its normal position in the arch. The patient’s occlusion was significantly improved with good aesthetic outcome, functional occlusion, and a stable result after 1.5 years of follow-up.
Orthodontic treatment of Class II, division 1 malocclusion in one or two phases is still controversial in contemporary Orthodontics. The present clinical case presents the orthodontic treatment of a 6-year-old patient with aesthetic complaint regarding the smile and bullying, presenting skeletal Class II, Class II malocclusion, Angle division 1, overjet with exaggerated protrusion of the maxillary incisors, exaggerated overbite with the lower incisors touching the palatal mucosa, absence of lip sealing and concave inferior face profile. In Phase I, rapid maxillary expansion was performed with Hyrax-type expander together with the Herbst fixed functional orthopedic device for 11 months. In Phase II, the fixed orthodontic appliance associated with intermaxillary elastics was used for 13 months. The two-phase treatment of Class II malocclusion, division 1 showed to be effective after 24 months, establishing adequate occlusal and functional results and improving the aesthetics of the lower third of the face.
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