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References

Thilander B, Myrberg N The prevalence of malocclusion in Swedish schoolchildren. Scand J Dent Res. 1973; 81:12-21 https://doi.org/10.1111/j.1600-0722.1973.tb01489.x
Ericson S, Kurol J Radiographic examination of ectopically erupting maxillary canines. Am J Orthod Dentofacial Orthop. 1987; 91:483-492 https://doi.org/10.1016/0889-5406(87)90005-9
Fleming PS, Scott P, Heidari N, DiBiase AT Influence of radiographic position of ectopic canines on the duration of orthodontic treatment. Angle Orthod. 2009; 79:442-446 https://doi.org/10.2319/042708-238.1
Fleming PS, Sharma PK, DiBiase AT How to…mechanically erupt a palatal canine. J Orthod. 2010; 37:262-271 https://doi.org/10.1179/14653121043200
Khoshkhouejad G, Ulhaq A, Bister D The ‘slingshot’ technique to align palatally impacted canines with elastomeric chain. J Orthod. 2015; 42:153-158 https://doi.org/10.1179/1465313314Y.0000000125.

A technique to apply elastomeric traction to impacted canines

From Volume 17, Issue 4, October 2024 | Pages 172-173

Authors

Rana Fard

Specialty Registrar in Orthodontics, UCLH Eastman Dental Hospital, London.

Articles by Rana Fard

Email Rana Fard

Robert Samuel David Smyth

Clinical Lecturer/Honorary Consultant in Orthodontics, UCL Eastman Dental Institute, London.

Articles by Robert Samuel David Smyth

Article

Impacted teeth are a common clinical scenario in orthodontics. Applying orthodontic traction to these teeth to aid mechanical eruption can be clinically complex and time consuming. This trick highlights an effective way to apply traction to an impacted canine using an elastomeric powerchain and a long stainless-steel ligature while reducing chairside time.

Commonly, impacted teeth are maxillary permanent canines, except for the third molars, with an incidence of 1.7% reported in the literature.1 These teeth often lie palatally,2 and mechanical eruption can be challenging, often prolonging the overall treatment duration.3

There are various clinical techniques and mechanics used to facilitate the successful and safe eruption of impacted palatal canines, such as transpalatal arches with auxiliary, piggyback NiTi wire, temporary anchorage devices, stainless-steel archwire auxiliaries (for example, ballista springs) and lastly, elastomeric traction to fixed appliances using either elastomeric powerchain or thread. It is important to use a range of techniques to manage impacted canines to achieve the best possible outcome efficiently.4,5

This Trick of the Trade involves attaching an elastomeric powerchain to gold chains to effectively apply distal and occlusal traction to transpalatal arches early in treatment, or buccal traction directly to fixed appliances later in treatment. This technique has six main steps (Figures 1–6).

Figure 1. Step 1: feed a long stainless-steel ligature through the end link of a piece of elastomeric powerchain (roughly 10–15 links) to produce a long, evenly twisted section of wire, which can be shortened to 15–20 mm with ligature cutters. A dental probe can be used to ensure a small diameter end loop at the powerchain.
Figure 2. Step 2: ensure the loop end tied to the powerchain is flattened using a Weingart instrument so that this wire section is narrow enough to be fed through a gold chain link.
Figure 3. Step 3: ask the assistant to hold the gold chain attached to the impacted tooth with a probe. Air dry the chain to ensure it is patent and clear of saliva. Use the twisted end of the stainless-steel ligature as a ‘needle’ to direct the powerchain through the desired gold chain link. This is usually the most gingival link. Apply pressure to stretch the powerchain through the gold chain link.
Figure 4. Step 4: use the twisted end of the stainless-steel ligature again to direct the powerchain through the final powerchain link, creating a lasso knot locked to the desired gold chain link.
Figure 5. Step 5: cut the powerchain to the required length for traction to be applied until mucosal blanching is achieved.
Figure 6. Step 6: stretch the powerchain and use the end link of the powerchain to loop this to a circle loop on a transpalatal arch to apply active traction to the impacted tooth. If desired, this can also apply traction to circle loops on a stainless steel archwire or other auxiliary attachments.

Using this technique to apply elastomeric traction to impacted canines is preferred by the authors compared to using elastomeric thread (i.e. Zing String) or cutting the end links of powerchain in half to reduce their width and using this thinner end to direct it through the gold chain link. The authors believe the method described is superior because it provides a more rigid directing system through a small link of a gold chain. This can sometimes make what is usually an uncomfortable procedure for patients a more efficient and comfortable experience. In addition, when using an elastomeric powerchain, it is easier to maintain the tension when applying traction than when using an elastomeric thread, which is more technique sensitive, and can lose tension rapidly.