Dipti Shastri et al
5005/jp-journals-10021-1317
CLINICAL INNOVATION
A New Rotation Correction Technique: Technique Clinic
1
Dipti Shastri, 2Pradeep Tandon, 3Gyan P Singh, 4Alka Singh
ABSTRACT
Tooth rotation is one of the problems among the eruption
disturbances which poses greater difficulty for correction. There
are various methods for the correction of tooth rotation. For
rotation correction, pure couple is required, but till date, none
of the mechanics provides pure couple and all have some
translatory vector involved in them. Here a newly developed
technique for rotation correction, which solely provides pure
couple to derotate the tooth, is being discussed, and is based
on the natural organization of gingival circular fibers.
Keywords: Rotation correction, Bracket piece, Elastic thread,
Pure couple.
How to cite this article: Shastri D, Tandon P, Singh GP, Singh A.
A New Rotation Correction Technique: Technique Clinic.
J Ind Orthod Soc 2014;48(4):566-569.
Source of support: Nil
Conflict of interest: None
Received on: 13/7/14
Accepted after revision: 6/8/14
INTRODUCTION
Tooth rotation is one of the problem among the eruption
disturbances which poses greater difficulty for correction
more so, if the tooth in rotation is present with adjacent
tooth malposition and inadequate space in the arch. Tooth
rotation can be defined as observable mesiolingual or
distolingual intra alveolar displacement of the tooth around
its longitudinal axis.1 Many rotations are associated with an
element of apical displacement and are difficult to correct
with removable appliance.2 There are various methods
for the correction of tooth rotation like, removable plate
with Z-spring, modified removable plate,3,5 whip spring,4,5
auxillary archwire and fixed appliance therapy,6 etc. For
rotation correction, the pure couple is required,7 but, till
date, none of the mechanics provide pure couple, and all
1
Senior Resident, 2Professor and Head, 3,4Associate Professor
1
Department of Orthodontics, Faculty of Dental Sciences, King
George Medical University, Lucknow, Uttar Pradesh, India
2-4
Department of Orthodontics and Dentofacial Orthopedics
Faculty of Dental Sciences, King George Medical University
Lucknow, Uttar Pradesh, India
Corresponding Author: Dipti Shastri, Senior Resident
Department of Orthodontics, Faculty of Dental Sciences, King
George Medical University, Lucknow, Uttar Pradesh, India
Phone: 919235768813, e-mail: drdiptishastri@gmail.com
566
10.
have some translatory vector. Here authors discuss the newly
developed technique for rotation correction which solely
provides pure couple to derotate the tooth, which is based
on natural organization of gingival circular fibers. It is well
efficient for the management of anterior as well as posterior
teeth rotation in both the arches.
PROCEDURE AND TECHNIQUE
1. Bracket was cut into two parts along with its long axis
(Fig. 1A), each part was bonded on the two edges of
the rotated tooth, one part was at the mesiolabial aspect
and another part was distolingual aspect of rotated
mandibular left central incisor, depending on the
direction of derotation of individual tooth (Fig. 1B). The
slots level of the both the halves of the bracket should
be at the same height as adjacent brackets to avoid any
vertical movement during derotation procedures.
2. The arch should be at least aligned and levelled with
0.018" stainless steel wire. The archwire was fabricated
in curved form in adaptation with the rotated tooth to
provide fulcrum to derotate at its own axis.
3. Elastic thread* was used as the active element, started
tying at the lingual surface of the distal end of bracket and
stretched it, took a one and half circle just in a circular
manner like the gingival circular fibers (Figs 1C and D).
Thread was passed through the slots of the brackets to
avoid the creeping or sliding of elastic thread in vertical
plane and finally tied at the site of curved wire segment
near the fulcrum to prevent any kind of undesirable tooth
movement.
CASE REPORT
The impacted left mandibular incisor was made to erupt
naturally by its own in 3 months but with rotation of about
80° (Fig. 2A).The new rotation correction technique was
applied for the particular tooth (Figs 2B to D). Rotation
correction was completed in 3.5 months. Subsequently,
the preadjusted bracket was bonded on the labial surface
for further detailing and finishing of the mandibular arch
(Figs 2E and F). Rotation correction was well seen in IOPA
X-ray (Fig. 2G). Finally, the retention was planned with fixed
retainer for 3 years after supracrestal fiberotomy.
*Ortho Organizers (San Marcos, California, USA)
 JIOS

A New Rotation Correction Technique: Technique Clinic

A B

C D

Figs 1A to D: (A) Bracket cut into two parts along its vertical axis, (B) both the half parts of bracket bonded on the mesiolabial and
distolingual surface of the teeth separately and elastic-thread (active element), knot tied on the distolingual bonded bracket and take a
one and half turn and passes through IB around the tooth and tied to curvature of the main archwire, (C) natural arrangement of gingival
fiber in rotated teeth and (D) biomechanics of derotation (I—active element elastic-thread one and half turn along the direction of gingival
fiber, II—center of rotation, III—curvature of the main archwire should be well adapted with the tooth to avoid any translatory move)

DISCUSSION tooth than fixed appliance. In fixed appliance, rotating

Several clinical treatment options have been proposed in
the literature for correction of rotated tooth, which includes
removable and fixed appliances, etc. Initially, Angle’s used
soldered eyelet to the edges of the bands, so a separate
ligature tie could be used to correct rotations or control the
tendency of rotation.2 Rotation control can also be achieved
without necessity for an additional ligature by using either
twin brackets or single brackets with extension wings that
contact the underside of the archwire to obtain necessary
moment in the rotational plane of space. Various springs
were used to correct rotation in removable appliace like
Z-spring, sectional wire or whip device, fine wire T-spring,
couple generation by labial bow and palatal spring, hooked
appliance, etc.5 Using removable appliances in correction
of rotated tooth act on one point contact resulting in tipping
movements which is less effective for the derotation of
springs7 were commonly used in the Begg8-11 and Tip-Edge12
techniques, and most preadjusted and standard edgewise
brackets do not had the vertical slots needed for such springs,
and auxillary wire was used with such brackets for rotation
correction. None of the above methods is efficient to correct
the tooth rotation on its own axis, and slightly translatory
movement was observed during correction. We developed
new technique for rotation correction, by which tooth rotates
along its long axis of rotation due to the fulcrum provided by
the close adaptation of the 0.018" stainless steel working arch
and by the generation of derotatory force in circular fashion
as like natural circular gingival fibers. This biomechanical
system promotes the derotation of tooth on its own long axis
(pure rotation). Result obtained was more stable and reduce
the total duration of treatment as compared to previously
used methods because of less round tripping.

The Journal of Indian Orthodontic Society, October-December 2014;48(4):566-569 567

Dipti Shastri et al

A B

C D

E F

Figs 2A to G: (A) IOPA X-ray before rotation correction, (B) after eruption rotation correction mechanics has been applied, (C) elastic
thread as active element for derotation, (D) frontal photograph, (E) bracket bonded over the labial surface of rotated tooth for final finishing
and detailing, (F) mandibular photograph and (G) IOPA X-ray of mandibular left central incisor after its rotation correction

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Relapse is commonly seen in rotated teeth and this is due
to rebound of elastic fibers in the supracrestal tissues and
can be reduced by pericision. The most common technique
is the circumferential supracrestal fiberotomy (CSF).13
This technique consists of inserting a surgical blade into
the gingival sulcus and severing the epithelial attachment
surrounding the involved teeth. The blade also transects the
transseptal fibers by interdentally entering the periodontal
ligament space. No surgical dressings are required and
clinical healing usually is complete in 7 to 10 days. The
CSF procedure is more successful for upper anterior teeth.
It is not recommended during active tooth movement or
where gingival inflammation is present due to unpredictable
regeneration of the epithelial attachment in such situations.
To avoid possible gingival recession, incising the epithelial
attachment is not recommended in the mid labial region of
any tooth with a narrow zone of attached gingiva or thin
cortical bone, so we have not done CSF in the lower incisor
rotation correction. This technique is well efficient for the
rotation correction of anterior, posterior tooth single as well
as multiple rotated tooth in either arch.
CONCLUSION
It is simple, economical, patient friendly and overall
predictable system for the management of rotated tooth. It
shortens the treatment time by providing controlled pure
couple force system to derotate the individual tooth. This
The Journal of Indian Orthodontic Society, October-December 2014;48(4):566-569
JIOS
A New Rotation Correction Technique: Technique Clinic
newly developed technique might prove to be a valuable
tool for rotation correction in the armamentarium of
orthodontists.
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