Eruption of Palatally Impacted Canines with a Novel SC Spring

Abstract

OBJECTIVES: A palatal impaction of the maxillary canine is observed in approximately 1-3% of patients and can present a challenge to the orthodontist. There have been many technique articles published about the repositioning of palatally impacted canines; this article proposes a novel technique to facilitate vertical eruption of the canines which can subsequently be moved into the arch with more conventional therapy. METHODS: This technique has been comprehensively documented in 2 patients. Once a palatally impacted canine is diagnosed clinically and with appropriate imaging, the canine is exposed with an open-window style technique. Anteriorly, a gold chain connects the exposed crown to the novel eruption spring, or SC spring. Posteriorly, the SC spring is attached to a Modified Nance through a lingual sheath and is secured with composite at the time of placement. The Modified Nance provides anchorage for forces created by the SC spring, resulting in efficient vertical eruption of the impacted canine. Once vertical eruption is achieved, conventional methods of arch alignment and root positioning are utilized to move the canine into the arch. RESULTS: The Modified Nance and SC Spring design presented here is a novel variation of the extrusion spring with several advantages. It is removable, modifiable, easily constructed, and its lingual point of attachment minimizes occlusal interferences. The SC Spring's removability allows for modification in the vertical, AP and transverse directions. It can be replaced if broken or distorted and provides a more continuous force than elastomerics; when combined with a Modified Nance design its reciprocal forces can be distributed over the palate and maxillary molars. CONCLUSIONS: The SC Spring, when used in combination with a Modified Nance appliance, is an effective and efficient method in the vertical eruption of palatally impacted canines to facilitate repositioning into more ideal alignment. IMPLICATIONS: This technique offers a relatively simple and novel method utilizing common materials to vertically erupt palatally impacted canines. The aim of this research is to identify its advantages and disadvantages, and potentially serve as a resource for orthodontists to use in practice.