1 - Palatally impacted cuspids generally are erupting lingually to the upper lateral incisor roots. The thick palatal tissue keeps the cuspid from erupting through into the mouth. To get an impacted cuspid over into the arch the gingiva over the crown of the cuspid must be removed. Then you can see what needs to be done to move the cuspids into the arch. After exposure and a little healing, attach either a button or a bracket to the crown of the cuspids. If you can, put them so they start rotating or aligning the impacted cuspids into a better position as they move into the arch.
2 - The cuspids are being moved laterally with small elastic thread that is tied from the attachment on the cuspids to the archwire. You can tie the elastic thread anywhere along the open coil spring which will help to keep it in place. Align the crowns of the teeth and do not worry about the alignment of the roots of the cuspids because we will deal with them later.
3 - The archwire now is an 18 stainless steel archwire with open coil springs to hold the spaces so the cuspids can be moved into the arch. This archwire is large enough so we can start lifting up the incisors to reduce the overbite using compensating curves in the buccal segments. As the cuspids move into the space created we have changed the brackets to the labial side of the teeth to get better control as they come down into the arch.
4 - After you get to this point you can finish the treatment like you would with any other patient.
5 - Notice that we did not have to do anything about the position of the roots. Dealing with the crowns first on this patient was enough for the root to be in good position when we finished the treatment. The total treatment time was 23 Months.
6 - There is minimal root resorption on the incisor teeth of less than 1 millimeter and no apparent root resorption on the cuspids even though they were tipped considerably. The total treatment time on this patient was 23 Months.
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