<p><strong>SOLUTION:&nbsp;</strong>Many doctors indicate that cuspids can be moved effectively using a removable appliance with direct bond buttons attached to the labial of the cuspids. Pressure for distal movement of the cuspids is exerted by the use of rubber ligatures placed from the buttons and extended distally to hooks on the molar clasps of the removable appliance.</p>

<p><img alt="Mesio-labially Displaced Cuspids - Click to Enlarge" src="https://www.ordont.com/images/problem-solution/P4232926_Mesio-labially.jpg" style="float:right; height:192px; width:220px" />The cuspid button is usually positioned in the middle third of the crown of the cuspid unless it is considerably tipped to the mesial in which case the button is positioned toward the cusp tip. The labial bow is normally brought from the labial to the lingual intreproximally between the cuspid and bicuspid. However, on cases involving cuspid retraction, soldering the bow to the molar clasps prevents interference with the cuspid, assists in lingual movement of the cuspid and avoids impingement of the ligature on the tissue. The appliance is retained with ball clasps between the bicuspids and adams clasps on the first molars.</p>

<p>The patient will become accustomed to the appliance if it is placed without pressure for the first week. After the initial activation of the rubber ligatures, slight discomfort and displacement can be expected for approximately one week. The appliance should then seat comfortably.</p>

<p>Rubber ligature pressure of approximately two ounces (4/16 or 5/16) is usually adequate and tolerable. As the cuspid moves distally, a smaller rubber ligature may be indicated to continue to maintain the same amount of pressure. Most doctors instruct their patients to change rubber ligatures nightly for optimal pressure and hygiene.</p>

<p>The time required for initial movement in response to ligature pressure varies between individual patients, depending on the patient&#39;s cooperation and reaction to orthodontic pressure. Lack of movement on a given patient would usually indicate a need for a more extended period of pressure rather than a greater amount of pressure.</p>

<p>Once the cuspid position is improved, the finger springs can be activated for improvement of the remaining anteriors. After active treatment, a retainer is usually worn for at least nine months and is reinserted monthly thereafter as a &quot;check guide&quot; against relapse.</p>
