PEARLS

Uprighting canines is challenging with lin-
gual appliances due to the narrow brackets and
short interbracket distances. This is particularly
evident with the Incognito* appliance, which has
vertical slots in the anterior brackets. The following
Pearl describes a masterful technique for upright-
ing canines after premolar extractions, using lin-
gual power arms and a custom-designed Incognito
canine bracket with an auxiliary horizontal slot.
NEAL D. KRAVITZ, DMD, MS
Associate Editor for Pearls
Root-First Lingual Canine
Retraction with Power Arms
ing. Root movement therefore follows space clo-
sure—a common approach with sliding mechanics
on continuous archwires.
When canine retraction is performed in lin-
gual orthodontics, the required uprighting is com-
plicated by the limited mesiodistal width of the
bracket slot. Power arms can be used to change the
point of force application so that the root is moved
first, thus avoiding the archwire bowing that other-
wise occurs when tipping is followed by uprighting.
Procedure
This procedure is demonstrated in a 26-year-
old female who presented with a Class II, division
2 malocclusion, distally inclined upper canines,
and anterior crowding (A). The upper first pre­

W
hen force is applied coronally to the center
of resistance (CR) during space closure, the
resultant tipping creates the need for root upright-
molars were extracted, Incognito brackets were
bonded, and leveling was performed up to .016" ×
*Trademark of 3M Unitek, Monrovia, CA; www.3MUnitek.com.

A C

B D

VOLUME LI  NUMBER 7 ©  2017 JCO, Inc. 427

PEARLS

.024" stainless steel wires. The incisor brackets

were not included initially to avoid proclination
during the leveling phase.
Incognito’s double canine bracket has an oc-
clusal slot and a gingival auxiliary tube (B), which
makes it possible to insert power arms made of
.017" × .022" stainless steel wire along with the MORTEN GODTFREDSEN LAURSEN, DDS
continuous archwire. The power arms are extend- Senior Clinical Instructor
ed apically to the CR of the canines and activated Section of Orthodontics
for canine uprighting and space closure by tighten- Department of Dentistry and Oral Health
ing stainless steel ligatures to palatal Aarhus** Aarhus University
mini-implants between the first molars and second Vennelyst Blvd. 9, DK-8000 Aarhus C, Denmark
premolars (C). Private practice
The roots of the distally inclined canines are Aarhus
moved first, ahead of the crowns. In this example, morten.godtfredsen.laursen@dent.au.dk
the “uprighting phase” was unnecessary. During
the final stages, power chains were added at the
bracket level to retract the canines bodily, using
forces apical and coronal to the CR. Spaces were
closed in 18 months, and the results remained
stable 35 months after treatment (D).

**Medicon eG, Tuttlingen, Germany; www.medicon.de. Dis­

tributed in North America and Europe by American Orthodontics, BIRTE MELSEN, DDS, DrOdont
Sheboygan, WI; www.americanortho.com.
Associate Editor
Journal of Clinical Orthodontics
Professor and retired Head
Aarhus University
Visiting Professor
Medizinische Hochschule
Hanover, Germany
Private practice
Lübeck, Germany

428 JCO/JULY 2017