Bilateral canine transpositions treated with lever arm mechanics and palatal miniscrews

Document Type

Article

Publication Title

Ajo do Clinical Companion

Abstract

This case report describes the orthodontic management of a rare complete bilateral maxillary canine–lateral incisor transposition in an 11-year-old female using lever-arm mechanics and palatal miniscrews, with emphasis on biomechanical strategies and clinical lessons learned. Cone-beam computed tomography revealed that the left canine was labially impacted, and the right canine was palatally impacted. Treatment aimed to restore normal tooth order without extractions, using palatal miniscrew anchorage, open-coil spring space creation, and cantilever lever-arm mechanics for root movement. Although the planned tooth positions were achieved, overexpansion during space creation and prolonged torque correction of the right canine root resulted in gingival recession, attachment loss, and incomplete torque recovery. At the 3-year follow-up, bilateral Class I occlusion and stable alignment with optimal overjet and overbite were maintained, but mild relapse and periodontal compromise persisted. This case report highlights that although lever-arm mechanics with palatal miniscrews can enable correction of even rare complete transpositions, such approaches carry significant biological and stability-related risks, underscoring the importance of recognizing treatment limits and carefully considering alternative strategies, including extraction, autotransplantation, and skeletal expansion, in complex transposition cases.

DOI

10.1016/j.xaor.2026.02.002

Publication Date

1-1-2026

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