Maxillary Impacted Canines Replaced with First Premolars: A 12-Year Clinical Follow-Up

A 12-year-old girl complained of an unsight smile and an unpleasant face, came to the Orthodontic Division of the University of Campania “Luigi Vanvitelli”. The patient presented a long and straight profile with an increased lower third of the face, slight chin deviation to the left, lip incompetence with perioral muscles strain at rest, and a non-harmonious smile with buccal corridors. The intraoral examination showed a Class I molar relationship on both sides, a severe and anomalous transverse constriction of the upper arch, bilateral crossbite (15-85, 25-75), a severe upper crowding and the presence of maxillary right deciduous canine, whereas the lower arch showed a mild crowding with lateral incisors missing. The panoramic x- ray showed bilaterally impacted permanent maxillary canines and confirmed lower lateral incisors absence. After a careful study of the clinical case, the treatment option chosen included the extraction of both impacted maxillary canines and their replacement with upper first bicuspids. This approach allowed, in a shorten treatment time (30 months), to maintain a molar class I relationship, to obtain a good overjet and overbite improving the patient’s smile and profile. Moreover, at the end of treatment cephalometric analysis revealed good maxillary and mandibular incisors inclination. Intraoral pictures taken 12 years after the end of treatment still showed well-maintained occlusal results, pointing out how impacted maxillary canine extractions and their replacing by using first upper bicuspids can be a good treatment option.