case_images: PMC4299428_01
case_images: Patient's initial photograph showing fixed appliance set with transposition
  between the upper left canine and lateral incisor, and the absence of upper
  central incisor on the same side.
case_images: dpjo-19-01-0106-g01.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g01.jpg
case_images: f01
case_images: Clinical examination revealed that the patient had permanent dentition with Angle Class II malocclusion on the left side due to migration of the posterior superior segment to a more anterior position; Class I malocclusion on the right side; upper midline deviation to the left; absence of tooth #21 with bulging in the vestibular region just below the anterior nasal spine (ANS), lack of space for its eruption, and transposition between teeth #22 and 23 (Fig 1).
case_images: Occlusal radiograph revealing impaction of tooth #21 with complete root
  formation.
case_images: dpjo-19-01-0106-g02.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g02.jpg
case_images: f02
case_images: Its root was fully formed (Fig 2) and had the coronal long axis in a more horizontal position between the middle and apical third of the adjacent teeth roots (Fig 3).
case_images: Lateral cephalogram revealing impaction of tooth #21 with coronal long axis
  horizontally positioned between the middle and apical third of adjacent teeth
  roots.
case_images: dpjo-19-01-0106-g03.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g03.jpg
case_images: f03
case_images: Its root was fully formed (Fig 2) and had the coronal long axis in a more horizontal position between the middle and apical third of the adjacent teeth roots (Fig 3).
case_images: Panoramic radiograph revealing impaction of tooth #21, #22 and #23 with incomplete
  transposition.
case_images: dpjo-19-01-0106-g04.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g04.jpg
case_images: f04
case_images: Incomplete transposition between teeth #22 and 23 and image overlap of tooth #22 root apex and tooth #21 root were confirmed (Fig 4).
case_images: Intraoral photographs with fixed appliance removed and new bands with triple tubes
  properly cemented. A) Right lateral view. B) Frontal view. C) Left lateral
  view.
case_images: dpjo-19-01-0106-g05.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g05.jpg
case_images: f05
case_images: After removal and prophylaxis, new bands and weld of upper triple tube and lower double tube were prepared, in addition to cementing them on the upper and lower first molars (Fig 5).
case_images: Intraoral photograph showing fixed appliance: A) Right lateral view. B) Frontal
  view and C) Left lateral view with TMA semiarch for #23 intrusion.
case_images: dpjo-19-01-0106-g06.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g06.jpg
case_images: f06
case_images: Thereafter, the fixed metal orthodontic appliance was set with 0.018 x 0.030-in slot in both arches, semi-arches of stabilization with blue 0.016 x 0.016-in Elgiloy wire on the lower right and left sides as well as on the upper right side, an utility arch (UA) in the lower arch, and, on the upper left side, a semi-arch with helicals for intrusion of tooth #13 with TMA 0.017 x 0.025-in wire, with intrusive force of 45 grams to attempt dental transposition (Fig 6).
case_images: Hilgers appliance properly installed.
case_images: dpjo-19-01-0106-g07.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g07.jpg
case_images: f07
case_images: After two days, the Hilgers appliance was installed for upper left molar distalization and anchorage of the upper premolars on the same side, thus, avoiding extrusion (Fig 7).
case_images: Quad-helix appliance installed to maintain distalization of #26.
case_images: dpjo-19-01-0106-g08.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g08.jpg
case_images: f08
case_images: The Hilgers appliance was removed and a quad-helix appliance (QH) was installed with 0.90 mm stainless steel wire to anchor and maintain upper left molar distalization (Fig 8).
case_images: Distalization of tooth #23 with closed NiTi spring and mesialization of #22 with
  open NiTi spring.
case_images: dpjo-19-01-0106-g09.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g09.jpg
case_images: f09
case_images: A semi-arch with rectangular 0.017 x 0.025-in stainless steel wire with 3/16-in medium elastic was also installed (Fig 9).
case_images: Upper arch alignment after transposition.
case_images: dpjo-19-01-0106-g10.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g10.jpg
case_images: f10
case_images: After transposition was completed, alignment and leveling were performed with 0.014-in NiTi wire (Fig 10) up to the 0.016 x 0.016-in square stainless steel wire for better stabilization.
case_images: Upper arch with open steel spring used to keep the space left for traction of
  retained tooth #21.
case_images: dpjo-19-01-0106-g11.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g11.jpg
case_images: f11
case_images: An open steel spring was used between teeth #11 and 22 to keep the recovered space that would be occupied by tooth #21 (Fig 11).
case_images: Traction of tooth #21 carried out with 0.014?/span> NiTi wire superimposed to
  0.016 x 0.016-in square stainless steel archwire with open spring between #11 and
  #22.
case_images: dpjo-19-01-0106-g12.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g12.jpg
case_images: f12
case_images: After 10 days, the sutures were removed and traction of tooth #21 began with 0.014-in NiTi wire superimposed to the square stainless steel archwire with open spring, by applying low magnitude forces in order to prevent unwanted movement of the adjacent teeth (Fig 12).
case_images: Final intraoral photographs: A) Frontal view with Hawley retainer. B) Occlusal
  view of upper arch with fixed retainer from tooth #11 to 23. C) Lower occlusal
  view with fixed lingual arch.
case_images: dpjo-19-01-0106-g13.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g13.jpg
case_images: f13
case_images: As for the lower dental arch, a fixed lingual arch fabricated with 0.80 mm stainless steel wire was adhered to the lingual surfaces of lower canines, with light-cured resin (Fig 13).
case_images: Final intraoral photographs: A) Right lateral view. B) Frontal view. C) Left
  lateral view.
case_images: dpjo-19-01-0106-g14.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g14.jpg
case_images: f14
case_images: The case has been finalized and it is currently under clinical (Fig 14) and radiographic follow-up (Fig 15).
case_images: Final panoramic radiograph.
case_images: dpjo-19-01-0106-g15.jpg
case_images: PMC4299428_01_dpjo-19-01-0106-g15.jpg
case_images: f15
case_images: The case has been finalized and it is currently under clinical (Fig 14) and radiographic follow-up (Fig 15).