IP Indian Journal of Orthodontics and Dentofacial Research 2024;10(1):29–35

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IP Indian Journal of Orthodontics and Dentofacial Research

Journal homepage: https://www.ijodr.com/

Original Research Article

Comparison of two methods in maxillary canine retraction

Melike Duran 1 *, Resul Altinisik 1, Ali Altug Bicakci 1

1 Dept. of Orthodontics, Gaziosmanpaşa University Faculty of Dentistry, Turkey

ARTICLE INFO ABSTRACT

Article history: Objective: The aim of this prospective clinical study is to evaluate the effects of laceback and Uprighter
Received 10-02-2024 techniques on maxillary canine retraction using digital models and panoramic radiographs and to compare
Accepted 03-06-2024 the results.
Available online 04-04-2024 Materials and Methods: Sixteen patients (10 females, 6 males) with an average chronological age of
16.24±2.99 years, requiring fixed orthodontic treatment with upper canines located in a high vestibular
position and the need for bilateral first premolar extraction, were included in this study. 0.018-inch Roth
Keywords: brackets were used in the patients. In this split-mouth design study, while laceback was used on one side,
Uprighter Uprighter was used on the other side. Tooth movements were measured on three-dimensional models and
Laceback
panoramic radiographs obtained at the beginning of treatment (T0), 2 months later (T1), and 3.5 months
Canine retraction
later (T2). Two-way analysis of variance was applied for the comparison of differences between the groups
in repeated measurements.
Results : The difference between groups was found to be statistically significant in terms of canine
distalization, canine rotation, and molar angulation amounts. There was no statistically significant
difference in the other parameters.
Conclusions: Both uprighter and laceback techniques can be applied in maxillary canine cases located
in the high vestibule. When Uprighter is used, the canine is distalized much more. However, it should be
noted that while more molar tipping may occur when laceback is used, more canine distopalatal rotation
may occur when uprighter is used.

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1. Introduction teeth to move vertically and take their place within the
arch. An additional method offered by the MBT technique
Maxillary canines positioned in the high vestibule are one during leveling is the use of laceback to connect the canine
of the most common conditions observed in orthodontic teeth, which not only facilitates vertical movement but also
practice, and this condition is strongly associated with directs the canine teeth distally. 5,6 In our study, this well-
crowding. 1,2 Treatment for this malocclusion typically established method, which can be considered as the gold
involves the extraction of first premolar teeth and the standard, was compared with a relatively new technique,
subsequent retraction of canine teeth into the extraction Uprighter application.
space. 3 The usual course of action in this treatment planning
often involves the placement of thin NiTi wires to bracket Uprighter, particularly in cases where the canines are
and level the teeth in the arch. 4 This allows the canine distally inclined, is a unique appliance that facilitates
the easy and rapid movement of the canine (PCT
* Corresponding author. number:W02016114731A1, Firdevs Dental Medical, USA).
E-mail address: [email protected] (M. Duran). It consists of a wire bracket divided into four parts: head,

https://doi.org/10.18231/j.ijodr.2024.006
2581-9356/© 2024 Author(s), Published by Innovative Publication. 29
 Duran, Altinisik and Altug Bicakci / IP Indian Journal of Orthodontics and Dentofacial Research 2024;10(1):29–35

neck, body, and a wire groove dividing the body into thick the upper second molars were not included in the treatment.
and thin legs. Uprighter is attached to the canines adjacent In this planned prospective clinical study with a split-
to the extraction space and the second premolars using an mouth design, the distance from the cusp tip of the
elastic chain, and it creates a small curve by bending the canines to the occlusal table was measured, revealing that
lightweight and round NiTi archwire (Figure 1). The force the canines were positioned in the high vestibule with
of the elastic chain brings the teeth closer together, and varying amounts ranging from 1.5 to 5 mm. The upper
thanks to the slope created in the archwire. As the teeth first premolars were extracted at the onset of treatment. In
move closer to each other with the force of the elastic chain, patients, 0.014-inch and 0.016-inch NiTi wires (Preformed
the inclination formed in the archwire ensures the closure Nickel Titanium, Ortho-Byte, Wilmington, USA) were
of the retraction space without the teeth tipping over. With sequentially used. Leveling and retraction were performed
this appliance, without the need for additional mechanics, simultaneously on these wires. While laceback was used on
all teeth begin to level in the first session by placing NiTi one randomly selected side, a size 2 Uprighter was used on
wires on all teeth. the other side (Figure 2). Treatment started with 0.014-inch
In the literature, there are only few studies carried out NiTi wire, and 0.016-inch NiTi wire was inserted after 2
on the retraction of canines located in the high vestibule months. The lateral incisors, which did not have crossbites
in both friction and non-friction systems and those studies and had sufficient space for leveling, were remotely tied
are case reports. 7–9 The effectiveness of the Uprighter has with elastic ligatures for the first 2 months. Subsequently,
not yet been investigated in any controlled study. This the archwire was fully seated in the brackets of these teeth.
study will contribute to the literature since it is the first The archwire was loosely ligated with wire ligatures to
study examining the effects of the laceback and Uprighter minimize friction on the canine brackets. Patients were
methods during the leveling phase. The aim of this study called for check-ups every 4 weeks. At each session, the
is to compare these two techniques. The null hypothesis laceback was activated, and the elastic chain was renewed,
suggests that there is no significant difference between the and a size larger Uprighter was placed. The study duration
two techniques in maxillary canine retraction. was planned to be a total of 3.5 months from the start
of treatment. Anchorage-reinforcing appliances such as
2. Materials and Methods transpalatal arch were not used in this study because we
believed they would complicate the interpretation of the
2.1. Study design and patients effects of laceback and Uprighter techniques on tooth
movement rates.
This study was approved by the Clinical Research To evaluate tooth movements, study models and
Ethics Committee of the ————-. All participants were panoramic radiographs were taken from patients at the
informed verbally and in writing about the study and beginning of treatment (T0), 2 months later (T1), and at
received an informed consent letter to read and sign. the end of the 3.5-month period (T2). The T0, T1, and T2
The inclusion criteria for the study are as follows: (1) models were digitized using a 3D scanner (MSD 400 Dental
Maxillary canines positioned high vestibularly within the Scanner, Pisa, Italy). They were then overlapped using
range of 1.5-5 mm. (2) Patients with skeletal Class 1 and Orthomodel (Pisa, Italy) analysis software. The medial
Class 2 malocclusions requiring bilateral maxillary first points of the right and left 3rd palatal rugae were used as
premolar extraction for orthodontic treatment purposes. (3) reference points for overlap, and the palatal rugae in the
Permanent maxillary central, lateral, canine, premolar, and anterior region of the hard palate were used for surface area
first molar teeth erupted. (4) Good oral hygiene. Patients measurement. 10,11
with poor cooperation, systemic and/or hormonal disorders, Canine distalization, rotation, extrusion, and anchorage
previous orthodontic treatment, and congenital deformities loss were measured on digital models, while canine,
such as cleft lip and palate were excluded from this study. 2nd premolar, and molar angulation were measured on
This study included 16 patients (10 female, 6 male) with panoramic radiographs.
upper canines located in the high vestibule, with a mean
chronological age at the start of treatment of 16.24±2.99
2.2. Dental cast and panoramic analysis
years. According to the power analysis conducted, it was
found that including 13 patients with 80% power, a 5% In the measurements conducted on the T0, T1, and T2
margin of error, and a 0.5 effect size would be sufficient models, the lowest part of the incisive papilla was taken
for this study. However, considering the potential decrease as the reference point. A vertical reference line parallel
that might occur during the study, it was conducted with to the median palatal suture passing through this point
16 patients. Fixed treatment with extraction of upper first was drawn. A perpendicular line was dropped from the
premolars was planned for each patient. Standard Velocity cusp tip of the canines and the mesial contact point of the
Series Roth brackets (Lancer Orthodontics, Vista, USA) first molars to this reference line. Canine distalization was
with a 0.018-inch slot width were used in each patient, and calculated by measuring the vertical distance between the

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point where the perpendicular line intersects the reference

line and the lowest part of the incisive papilla in the T0, T1,
and T2 models (Figure 3). Canine rotation was calculated
by measuring the angle between the reference point and
the points placed on the mesial and distal contact points
of the canine (Figure 4). For canine extrusion, the vertical
distance between the cusp tips of the canines along the long
axis of the tooth was measured in the overlapped T0-T1,
T1-T2, and T0-T2 models (Figure 5). Anchorage loss was
calculated by measuring the vertical distance between the
point where the perpendicular line dropped from the mesial
contact point of the first molar intersects the reference plane
and the lowest part of the incisive papilla in the T0, T1, and
T2 models (Figure 3).
In the radiographs, the lower points of the right and
left orbits were joined to create the reference line for the
upper jaw. 12 Lines connecting the apical and coronal points
of the palatal root canal of the molar teeth and the apical
and coronal points of the root canals of the canine and
second premolar teeth were drawn to create the molar and
canine/premolar axes, respectively. The angles formed by
these axes with the reference line for the upper jaw were
measured using a digital protractor, and angular changes in
the respective teeth were evaluated (Figure 6).

2.3. Statistical analysis

Figure 1: Uprighter
Statistical analysis was conducted using the IBM SPSS
Statistics 22 software (SPSS Inc., an IBM Co., Somers,
NY). Repeated measures two-way analysis of variance
(ANOVA) was employed to compare the means of
repeated quantitative variables between groups. Bonferroni
correction was applied for within-group comparisons. For
within-group comparisons, repeated measures ANOVA
was used, and for between-group differences, the test
of significance of the difference between the means
was utilized. To control for measurement error, the
measurements of 9 randomly selected patients were
repeated.

3. Results
Examining intra-class correlations, it was determined that
the correlation coefficients ranged between 0.974 and 1 for
all parameters measured. This result suggests a high level of
consistency between the measurement values.
Descriptive values and intergroup comparisons of dental
variables (canine, 2nd premolar, and molar) for the
periodical (T0-T1, T1-T2) and total durations (T0-T2) are
provided in Table 1.

4. Comparison of Changes Between Uprighter and Figure 2: Changes observed with uprighter and laceback (T0,T1
Laceback Groups and T2).
A statistically significant difference was found between
the Uprighter group (4.38 mm) and the laceback group

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Table 1: Descriptive values and intergroup comparison of dental (canine, second premolar and molar) variables occurring in periodic
(T0-T1, T1-T2) and total times (T0-T2).
Method
Değişkenler Uprighter Laceback F P
Ort±SS Ort±SS
T0_T1 distalization 3.09±1.43 (a) 2.18±1.66 (a) 2.768 0.107
T1_T2 distalization 1.29±0.98 (b) 1.12±0.82 (b) 0.279 0.601
T0_T2 distalization 4.38±0.91 (c) 3.29±1.46 (c) 6.320 0.018*
F;p 119.984; <0.001 71.317; <0.001
T0_T1 rotation -6.21±3.12 (a) -1.21±6.44 (a) 7.828 0.009*
T1_T2 rotation -1.94±2.42 (b) -1.56±3.42 (a) 0.133 0.718
T0_T2 rotation -8.15±3.31 (c) -2.76±7.21 (a) 7.382 0.011*
F;p 16.331; <0.001 2.789; 0.078
T0_T1 ekstrusion 2,25±0,91 (a) 2.26±1.23 (a) 0.001 0.987
T1_T2 ekstrusion 0,75±0,72 (b) 0.77±0.66 (b) 0.006 0.939
T0_T2 ekstrusion 3±0,76 (c) 3.03±1.22 (c) 0.005 0.945
68.589; <0.001 69.850; <0.001
T0_T1 canine tipping 3.69±4.97 (ab) 3.91±5.33 (a) 0.014 0.905
T1_T2 canine tipping -1.03±4.2 (a) -2.29±4.07 (b) 0.740 0.396
T0_T2 canine tipping 2.69±4.1 (b) 1.62±6.02 (a) 0.346 0.561
F;p 4.018; 0.029 4.987; 0.014
T0_T1 premolar tipping -1.42±5.1 (ab) -0.63±1.93 (a) 0.339 0.565
T1_T2 premolar tipping -1.12±5.5 (b) -1.04±2.65 (a) 0.003 0.956
T0_T2 premolar tipping -2.54±4.92 (a) -1.66±2.45 (a) 0.409 0.527
F;p 3.439; 0.046 1.417; 0.259
T0_T1 molar tipping -0.7±2.45 (a) -2.64±1.54 (a) 7.228 0.012*
T1_T2 molar tipping -1.75±2.02 (ab) -2.3±2.08 (a) 0.574 0.455
T0_T2 molar tipping -2.45±2.27 (b) -4.94±1.6 (b) 13.339 0.001*
F;p 12.617; <0.001 49.555; <0.001
T0_T1 anchor loss 0.73±0.38 (a) 0.66±0.36 (a) 0.279 0.601
T1_T2 anchor loss 0.46±0.44 (a) 0.63±0.55 (a) 0.880 0.356
T0_T2 anchor loss 1.2±0.49 (b) 1.29±0.56 (b) 0.270 0.607
F;p 49.527; <0.001 51.878; <0.001
*P<.05 significance, (abc): A common letter as a colon indicates statistical insignificance.

Figure 3: Measurement of canine distalization and anchorage loss Figure 5: Measurement of canine extrusion

Figure 6: Measurement of canine, second premolar and molar

Figure 4: Measurement of canine rotation angulation

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(3.29 mm, P=0.018) in terms of T0-T2 canine distalization found to be at least as reliable as other methods. 17
(Table 1).
In the Uprighter group (4.38 mm), there was more canine
The T0-T1 canine rotation (6.21◦ distopalatal in the distalization in the total time (T0-T2) when compared
Uprighter group; 1.21◦ distopalatal in the laceback group, to the laceback group (3.29 mm). The higher level of
P=0.009) and T0-T2 canine rotation (8.15◦ distopalatal in distalization in the Uprighter group is an expected outcome
the Uprighter group; 2.76◦ distopalatal in the laceback due to the elastic chain force. The lesser canine distalization
group, P=0.011) were higher in the Uprighter group. This observed in the laceback group is attributed to the heavy and
difference between the groups was statistically significant intermittent force characteristics of the laceback ligatures. 5
(Table 1). In addition, the Uprighter distributes the orthodontic force
The mesial tipping value of the first molar was higher in along the canine root by bending the archwire and this
the laceback group (T0-T1=2.64◦ , P=0.012; T0-T2=4.98◦ , force can be considered as a biological force that allows
P=0.001) compared to the Uprighter group (T0-T1=0.7◦ , faster canine movement. In a study comparing the effects of
P=0.012; T0-T2=2.45◦ , P=0.001). This difference between laceback ligatures applying 150 g force and NiTi closed coil
Moreover, it was observed that the second premolar tooth springs on canine retraction, Sueri and Türk reported 1.67
exhibited mesial tipping of 2.54◦ between T0-T2 in the mm canine distal movement in the laceback ligature group
Uprighter group and 1.66◦ in the laceback group. This and 4.07 mm in the NiTi closed coil spring group. 6 Despite
difference between groups was not statistically significant using the same wires as the study carried out by Sueri
(p>.05) (Table 1). and Türk, the lower level of distal movement of canines in
There were no statistically significant differences the laceback side in the present study is due to the initial
between the groups in the other variables (P>.05) (Table 1). positioning of canines in the high vestibule, a longer study
period, and the possibility of applying a higher level of force
4.1. Harm during laceback placement depending on the practitioner.
Moreover, in the study carried out by Sueri and Türk, the
As the maxillary canines were retracted, the reduction
higher level of distal tipping of canines was attributed to the
in extraction space necessitated the placement of larger
use of 0.022-inch brackets, which resulted in more space
Uprighters each month. Additionally, due to concerns about
between the archwire and bracket slot when compared to the
the Uprighter separating from the wire while brushing, some
present study. In another study, canine distal movement was
patients may have neglected to brush this area effectively,
observed as 0.98 mm in the laceback group and 1.09 mm in
resulting in more challenging maintenance of oral hygiene
the modified group. 16 The lesser distal movement observed
on the side where the Uprighter was applied.
in their study is attributed to the canine retraction being
performed on 0.019x0.025-inch SS wires and the higher age
5. Discussion range of the patients compared to the present study.
In most of the studies in the literature, maxillary canines In the T0-T1 and T0-T2 periods, a higher level of
located in the high vestibule were retracted by using distopalatal rotation was found in the canine teeth of
segmental mechanics in a frictionless system, and no the Uprighter group (6.21◦ , 8.15◦ ) in comparison to the
information has been provided regarding the initial position laceback group (1.21◦ , 2.76◦ ). This finding indicates that
of canines in these studies. These studies are case reports laceback ligatures provide more controlled tooth movement
and do not have a sufficient sample size. 7–9 The present in terms of buccolingual rotation. Distopalatal rotation can
study will contribute to the literature since it is the first study occur in canine teeth since the point of force application
examining the effects of laceback and Uprighter methods during canine retraction is buccal to the resistance center of
used during the leveling phase in a frictional system. the tooth. Since the Uprighter pushes the archwire slightly
Hoggan and Sadowsky 11 reported that the lateral points palatally rather than vertically, it is expected to observe
of the 3r d palatal rugae could be affected in canine tooth more distopalatal rotation in the Uprighter group. This
movement. In this study, superimpositions were performed phenomenon is also attributed to the higher level of force
by making references to the studies indicating that overlaps applied distally to the canine in the high vestibule area in
are stable regions for palatal rugae in the anterior region of the Uprighter group when compared to the force applied
the hard palate and that the medial side of the 3r d palatal mesially, in comparison to the laceback group. The rotation
ruga can be used for overlaps. 10,13 measured for the period T1-T2 in the Uprighter group
Various methods are used in measuring tooth is significantly less than that measured between T0-T1.
movement. 6,14–16 However, 3D digital models were This can be explained by the attachment of laterals in the
preferred in the present study in order to enable more first 2 months and the creation of an anti-rotation moment
precise measurements by eliminating disadvantages such as due to the application of larger Uprighter wires in each
ionizing radiation. In addition, panoramic radiographs were session. Although the mean values in the laceback group
used for better determination of root angulation, as it was show distopalatal rotation, distobuccal rotation occurred in

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5 patients when lateral incisors were included in the study. 7. Conclusion

This is thought to be due to the higher force applied mesially
When compared to the laceback technique, the use of
than distally on the canine tooth due to the shorter inter-
Uprighters resulted in much greater distalization of the
bracket distance at the mesial of the canine. The finding
canine without causing unwanted tipping complications.
reported by Sueri and Türk detecting 2.68◦ distobuccal
However, it should be noted that while using laceback may
rotation in the laceback group supports this idea. 6 Rajchich
lead to more molar tipping, using Uprighters may result in
and Sadowsky found 15.3◦ distopalatal rotation in canine
greater distopalatal rotation of the canine.
teeth. In their study with Ni-Ti closed coil springs, whereas
Ziegler and Ingervall reported a 30◦ distopalatal rotation
in the PG retraction spring group and 24◦ in the elastic 8. Source of Funding
chain group. 15–18 The amount of rotation that occurs during None.
the canine retraction in friction-based systems is influenced
by factors such as the intensity, type, and duration of the 9. Conflict of Interest
applied force, as well as the elasticity of the archwire used.
Although no statistically significant difference was None.
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Author biography Cite this article: Duran M, Altinisik R, Altug Bicakci A. Comparison
of two methods in maxillary canine retraction. IP Indian J Orthod
Dentofacial Res 2024;10(1):29-35.
Melike Duran, Assistant Professor https://orcid.org/0000-0002-6367-
8025

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