After the space was opened, the "Double Bracket" technique was applied to apply a translation movement rather than simply a tipping force that would have been much less efficient. The photo below shows the bracket placement that was used on the gingival third of the three teeth used in this example.





Within a number of weeks (to be confirmed at the time of posting this article) the patient experienced a marked improvement in the position of the lateral incisor and the decision was made to move back into the typical bracket position (as shown below) and final alignment and space closure steps would follow. Uneven wear of the adjacent central would be addressed at the de-bracketing appointment or at a subsequent visit.



Photo of teeth after removal of the double brackets (above).



Photo of placement of the brackets in typical setup with continuation of the orthodontic process. This technique should be used with a dentist/orthodontist's own discretion and progress should be closely monitored to avoid possible complications. Final images to follow.

Images provided by Dr. M. Zuk. Copyright 2009.



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The image above demonstrates a patient with a upper left lateral that is blocked out towards the palatal side. The difference if the length and width of the central incisors would be addressed later in treatment with selective recontouring and bonding as required (not the subject of this article).




Occlusal view of the same patient. After discussing a number of alternatives (including the use of a distalizing appliance along with TAD's) the simpler option was chosen which involved using High Speed Braces^TM combined with selective extractions.

The first maxillary bicuspids were removed to both reduce overjet and allow room for the laterals the space for the blocked out lateral was opened using springs on the archwire. Picture below demonstrates the progress after using the open coils.