Trying to finish this case. Patient is not happy with canines. This will be my first time using triangle elastics. Doing this on both sides. Does this setup look good? What weight of elastics do yall recommend? Should o increase tray wear time to 2 week? Should elastics be worn 22 hours a day? Thanks in advance for any insight

Answer

In this case, the canines have not completed their rotation, despite good overall movement of the other teeth. Since there’s good movement on the other teeth, the patient likely has good compliance. The canines are less erupted than before, likely due to the "watermelon seed effect," where insufficient space causes neighboring teeth to squeeze the canine, pushing it upward. To address this, it's suggested to create extra space, about 0.1 millimeters mesial and distal to the canines, which could prevent further intrusion and facilitate proper movement.

Additionally, using triangle elastics can help with vertical movement, but may not be sufficient for rotation. To improve both rotation and extrusion, an oblique attachment, or "sash" attachment, can be used. This attachment is beveled towards the gingiva, providing a surface to apply force for simultaneous rotation and extrusion of the tooth. This approach targets the specific challenges posed by the lack of space and the unique movements required.

In cases where the canine is blocked out or difficult to move from the start, it's recommended to focus on extruding the tooth first and then address rotation in a refinement stage. The elastic used should be appropriately sized and tensioned to ensure effective engagement and movement, typically a 3/16, 4.5-ounce elastic in this context. This strategic approach addresses both the lack of space and the need for complex tooth movements.