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Arriola-Guillén LE, Rodríguez-Cárdenas YA, Ruíz-Mora GA, Aliaga-Del Castillo A, Dias-Da Silveira HL, Dutra V. Effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position: A systematic review. Int Orthod 2024; 22:100916. [PMID: 39181039 DOI: 10.1016/j.ortho.2024.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Treatment of impacted upper incisors in a labially inverted position is challenging for orthodontists, and its prognosis has not been established in the literature. Thus, this systematic review aimed to determine the effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position. METHODS A comprehensive search was conducted in multiple databases, including MEDLINE (via PubMed), Scopus, Embase, Science Direct, and LILACS, up to June 30, 2024. Initially, 1640 articles were identified, and after applying specific selection criteria, 11 articles were selected for full-text evaluation. Following the review, only six studies were deemed relevant, comprising one before-and-after study, two longitudinal retrospective studies, and three cross-sectional studies. Newcastle-Ottawa and Risk of Bias (ROB-2) tools were used to assess the risk of bias in the selected studies. RESULTS The average duration of traction for maxillary labially inverted impacted central incisors ranged from 8.60±1.26months to 18±6.0months, with all cases being successfully treated. Following traction, the clinical crown height of the incisors was significantly higher compared to the control group (P<0.01). Similarly, the root length of the impacted incisors after traction was shorter in the impaction group (approximately 2mm) compared to the control group. Likewise, the thickness of the alveolar bone varied among different studies. Some authors noted that the treatment group had a smaller thickness (about 0.5mm) compared to the control group (P<0.05), while other authors found similar thickness after treatment. CONCLUSIONS Although there are few reported studies with a low risk of bias, it is clear that it is possible to successfully treat labially inverted impacted maxillary central incisors with apparently few side effects. Following traction, the clinical crown height of these incisors increased, while the root length was shorter than their normally erupted contralateral teeth.
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Affiliation(s)
| | | | | | | | - Heraldo Luis Dias-Da Silveira
- Department of Oral Surgery and Orthopedics, Division of Dental Radiology, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinicius Dutra
- Department of Oral Pathology, Medicine, and Radiology, School of Dentistry, Indiana University, Indiana, USA
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Sobouti F, Ghadirian H, Dadgar S, Aryana M, Kamali E. Radiographic assessment and management of two deeply and horizontally impacted maxillary central incisors: A clinical case report. Radiol Case Rep 2024; 19:3089-3095. [PMID: 38770383 PMCID: PMC11103363 DOI: 10.1016/j.radcr.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024] Open
Abstract
This case report describes the treatment of a 9-year-old boy with impacted maxillary central incisors due to 2 supernumerary teeth. A sequential approach comprising of surgical removal of the supernumerary teeth and 2 stages of surgical exposure and orthodontic traction of the impacted teeth resulted in correct repositioning of incisors. Close monitoring and multidisciplinary cooperation during various stages of treatment led to a successful esthetic outcome, with optimal periodontal health and functional occlusion.
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Affiliation(s)
- Farhad Sobouti
- Department of Orthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hannaneh Ghadirian
- Department of Orthodontics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Dadgar
- Department of Orthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Aryana
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elaheh Kamali
- Department of Orthodontics, Tehran University of Medical Sciences, Tehran, Iran
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Wang Y, Chen X, Zhou D, Zheng L, Li X, Peng Y. Appropriate timing of treatment contributes to better root development of impacted anterior teeth in children. Am J Orthod Dentofacial Orthop 2024; 165:18-26. [PMID: 37656074 DOI: 10.1016/j.ajodo.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION This study investigated the effects of different timings of orthodontic treatment on the root development of impacted anterior teeth in children. METHODS The cone-beam computed tomography (CBCT) data of 45 children with impacted anterior teeth were divided into unformed root (UR) group or basically formed root (BFR) group to evaluate root length (RL) and root growth length (RGL) of impacted teeth and contralateral nonimpacted teeth pretreatment and posttreatment. In addition, 22 patients with impacted dilaceration were selected to assess the effects of the crown-root angle and root development stage on RL and RGL. The Student t test, Wilcoxon test, analysis of variance, and multiple linear regression analysis were used for statistical evaluations. RESULTS The RL of treated impacted teeth pretreatment and posttreatment was significantly shorter than contralateral nonimpacted teeth values (P <0.05). Posttreatment, the RL and RGL of impacted teeth of the UR group were significantly greater than those of the BFR group (P <0.05). The RGL of the dilacerated root in the UR group was considerably higher than in the BFR group (P <0.05). The larger crown-root angle group had a longer posttreatment RL (P <0.05). Multiple linear regression analysis revealed that the Nolla stage of impacted teeth and RL of contralateral teeth pretreatment significantly influenced the RL of impacted teeth posttreatment. CONCLUSIONS Prompt orthodontic treatment is necessary for children with impacted anterior teeth to release the impacted state and achieve better root development. The root length of a dilacerated tooth continued to develop under treatment, but the crown-root angle partly constrained it.
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Affiliation(s)
- Yi Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqian Chen
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Center of Stomatology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China
| | - Dan Zhou
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Liwei Zheng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiaobing Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yiran Peng
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Marek I, Janková A, Starosta M, Novosad M, Kučera J. Comparison of spontaneous eruption and modified closed eruption technique with palatal traction in alignment of impacted maxillary central incisor teeth. Prog Orthod 2023; 24:17. [PMID: 37357250 DOI: 10.1186/s40510-023-00470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/20/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Central incisor impaction is a rare condition with potentially severe clinical and psychological implications for the patient. Treatment techniques vary according to the pretreatment situation and individual factors. The aim of this study was to compare the esthetic outcomes and treatment times between two different approaches. MATERIALS AND METHODS In this retrospective study, thirty-one consecutive patients (13 boys, 18 girls; average age 9.5 ± 2.3 years) with a total of 34 impacted permanent upper central incisors were included in the study. Patients were divided into two groups according to method of treatment. Group A comprised patients in whom spontaneous eruption occurred after space opening (n = 12), and Group B comprised patients in whom teeth showed no eruption and required treatment with a modified closed eruption method with palatally oriented traction (n = 19). Treatment time and esthetic outcomes were assessed and compared between groups. RESULTS The mean treatment time was 22.0 ± 6.7 months, and all teeth were successfully aligned. No statistically significant difference in average treatment time was found between groups in baseline characteristics (p > 0.05). The amount of attached gingiva was significantly smaller when compared to contralateral reference teeth in the closed eruption group (Group B; p = 0.03). However, no difference in amount of attached gingiva was found between both groups (p = 0.26). Additionally, no difference in the clinical crown length was found between groups (p = 0.27). CONCLUSION The closed eruption method with palatal traction directed at the peak of the alveolar crest provided results comparable to the physiologic tooth eruption.
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Affiliation(s)
- Ivo Marek
- Department of Orthodontics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Palackeho 700/12, 779 00, Olomouc, Czech Republic
- STOMMA Dental Clinic, Tř. 1. máje 3414/11A, 690 02, Břeclav, Czech Republic
- Department of Orthodontics, First Faculty of Medicine, Charles University and the General University Hospital in Prague, Kateřinská 32, Prague 2, 12800, Prague, Czech Republic
| | - Anna Janková
- Department of Orthodontics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Palackeho 700/12, 779 00, Olomouc, Czech Republic
- STOMMA Dental Clinic, Tř. 1. máje 3414/11A, 690 02, Břeclav, Czech Republic
| | - Martin Starosta
- Department of Orthodontics, First Faculty of Medicine, Charles University and the General University Hospital in Prague, Kateřinská 32, Prague 2, 12800, Prague, Czech Republic
| | - Michal Novosad
- STOMMA Dental Clinic, Tř. 1. máje 3414/11A, 690 02, Břeclav, Czech Republic
| | - Josef Kučera
- Department of Orthodontics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Palackeho 700/12, 779 00, Olomouc, Czech Republic.
- Department of Orthodontics, First Faculty of Medicine, Charles University and the General University Hospital in Prague, Kateřinská 32, Prague 2, 12800, Prague, Czech Republic.
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The effect of the root dilaceration on the treatment duration and prognosis of unilateral impacted immature maxillary central incisors. Am J Orthod Dentofacial Orthop 2023; 163:79-86. [PMID: 36202699 DOI: 10.1016/j.ajodo.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/01/2021] [Accepted: 08/01/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION This study aimed to investigate the effect of root dilaceration on the closed-eruption technique treatment and prognosis on impacted immature maxillary central incisors. METHODS In this retrospective study, we compared the age at the beginning of the treatment, the treatment duration, root development, and alveolar bone mass after the closed-eruption technique between the impacted immature maxillary central incisors with dilacerated roots (group 1) and those with straight roots (group 2). RESULTS The mean age at the time of the surgery of group 1 was 0.9 years younger than that of group 2 (P = 0.008). The mean traction time was greater in group 1 (8.0 ± 1.8 months), with a difference of 1.4 months than in group 2 (6.6 ± 2.1 months) (P = 0.042). The measurements of lingual bone thickness at the alveolar crest (C) showed significant differences between the 2 groups (P = 0.025). No significant differences were found in other treatment duration or measurements of root development and alveolar bone mass between the 2 groups. CONCLUSIONS Patients with impacted immature incisors with dilacerated roots were younger at the beginning of the closed-eruption treatment and had a longer traction time than those with impacted immature incisors having straight roots. The root dilaceration had little or no effect on root development and alveolar bone mass after the closed-eruption treatment. The closed-eruption treatment of impacted immature incisors with root dilaceration is suggested to commence as early as possible.
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Orthodontic management of a horizontally impacted maxillary incisor in an adolescent patient. Am J Orthod Dentofacial Orthop 2023; 163:126-136. [PMID: 36192324 DOI: 10.1016/j.ajodo.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/27/2022]
Abstract
Horizontal maxillary incisor impaction is not common, but it affects facial esthetics, phonetics, and the patient's self-esteem. Therefore, it is necessary to manage this problem as early as possible. This case report presents a patient with an unerupted maxillary left central incisor combined with anterior and left posterior crossbite, edge-to-edge overbite on the right and left anterior open bite, low smile line, and mild skeletal Class III discrepancy. The treatment consisted of 3 stages: (1) maxillary expansion and sufficient space creation for the impacted tooth; (2) surgical exposure by closed-eruption technique; and (3) induced eruption of impaction. The treatment outcome was highly favorable. Maxillary impaction erupted in the proper position with a normal clinical crown height and consonant gingival line with the adjacent teeth. Maxillary and mandibular teeth had normal and stable occlusion. The 3-year follow-up demonstrated an esthetically functional outcome after orthodontically induced tooth eruption. This treatment required a good treatment plan by the orthodontist to obtain satisfactory results.
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Root Dilaceration: A Case Report and Literature Review. AUSTRALASIAN ORTHODONTIC JOURNAL 2023. [DOI: 10.2478/aoj-2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Abstract
The clinical management of impacted incisors affected by root dilaceration is challenging. This case report presents the treatment of an adolescent female patient who presented with a deeply impacted, rotated and dilacerated maxillary central incisor and also reviews the current literature on the definition, prevalence, aetiology, diagnosis, and treatment of the anomaly. The impacted and dilacerated incisor was successfully orthodontically treated following a two-stage surgical exposure and after being rotated 100 degrees in the sagittal plane (due to the deep impaction and severe displacement). A Ballista spring and piggyback appliance technique were used to elevate the tooth. The dilacerated incisor was successfully preserved and relocated in the dental arch. The pre-operative and post-operative CBCT scans showed no significant root resorption of the repositioned tooth.
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Zhao L, Matsumoto Y, Iseki S, Ono T. Effects of short-term orthodontic force application on the root at different developmental stages in rat maxillary molars. Am J Orthod Dentofacial Orthop 2022; 163:531-539.e2. [PMID: 36564315 DOI: 10.1016/j.ajodo.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The suitable timing and duration of orthodontic force to be applied to teeth with developing roots are unclear. We investigated the effects of short-term orthodontic force application on the roots at different root developmental stages in rats to predict the optimal timing for orthodontic treatment of teeth with developing roots. METHODS Light orthodontic force was applied on the maxillary first molars of rats from postnatal day (PN) 21 or PN28 for 3 days. After that, the force was released, and the roots were evaluated on PN35 to determine the root length, apical morphology, and cell proliferation of the maxillary first mesial roots using microcomputed tomography and histologic evaluation. RESULTS When a light orthodontic force was applied from PN21, the root length did not differ from that in age-matched controls. In addition, after the force was released, the roots attained the normal root-completing length and had a well-formed root apical morphology at PN35. Conversely, when the force was applied from PN28, the roots showed apical abnormalities characterized by deformed dentin and disorganized arrangement of odontoblasts, reduced apical cell proliferation, and significantly shorter length than those in the age-matched controls at PN31. The shortened root and disturbed apical integrity could not be rescued by releasing the orthodontic force at PN35. CONCLUSIONS Short-term orthodontic force at the late and slow root developmental stage results in a shortened root and a defect in the root apex with reduced cell proliferation. Our findings support that orthodontic force for a limited duration during the active and rapid root developmental stage is more favorable than during the late and slow stage.
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Affiliation(s)
- Lu Zhao
- Department of Orthodontics, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China; Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Molecular Craniofacial Embryology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiro Matsumoto
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Sachiko Iseki
- Department of Molecular Craniofacial Embryology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ono
- Department of Orthodontic Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Lana Mattiello FD, Deon Rizzatto SM, Macedo de Menezes L, Araújo EA, Kim KB, Martinelli de Lima E. Dimensional and morphologic characteristics of unilateral impacted maxillary central incisors. Am J Orthod Dentofacial Orthop 2022; 162:340-347. [PMID: 35568599 DOI: 10.1016/j.ajodo.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This cross-sectional study aimed to investigate the crown and root characteristics of impacted central incisors compared with spontaneously erupted contralateral incisors and the influence of etiologic and local factors on their dimensions. METHODS Forty-five patients (22 boys, 23 girls) who underwent orthodontic treatment for unilateral impaction of maxillary central incisors were referred for cone-beam imaging. Dimensions of the impacted and contralateral incisors were assessed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). Paired t test and linear regression were used to compare the characteristics of the impacted and contralateral teeth. RESULTS Contralateral and impacted central incisors showed statistically significant differences for root length (95% confidence interval [CI], 2.32-3.46; P <0.001), mesiodistal crown-root angulation (95% CI, 4.09-15.95; P = 0.001), and labiolingual crown-root angulation (95% CI, -18.69 to -4.70; P = 0.002). Etiologic factors did not alter the dimensions of incisors (95% CI, -1.17 to 0.76; P = 0.672). According to the multiple linear regression the independent variables associated with root length of contralateral and impacted incisors were sex (β = -0.904; 95% CI, -1.62 to - 0.19; P = 0.014) and the presence of impaction (β = -2.87; 95% CI, -3.67 to -2.07; P <0.001). CONCLUSIONS Regardless of their etiology, the impacted incisors showed roots that were 2.89 mm shorter than the contralateral incisors and had greater angulation in the mesiodistal and labiolingual directions. Girls showed a reduction of 0.904 mm (7.6%) on the lengths of roots of both impacted and contralateral central incisors. The presence of impaction led to a reduction of 25% in incisor root lengths. Approximately 30% of the impacted teeth showed crown-root angulations >20° resulting in an increased distal and labial angulation of the root apical portion.
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Affiliation(s)
- Fabiano Dalla Lana Mattiello
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Susana Maria Deon Rizzatto
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane Macedo de Menezes
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eustáquio Afonso Araújo
- Department of Orthodontics, School of Dentistry, Saint Louis University, St Louis, Mo, Brazil
| | - Kim Beom Kim
- Department of Orthodontics, School of Dentistry, Saint Louis University, St Louis, Mo, Brazil
| | - Eduardo Martinelli de Lima
- Department of Orthodontics, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Wu G, He S, Chi J, Sun H, Ye H, Bhikoo C, Du W, Pan W, Voliere G, Hu R. The differences of root morphology and root length between different types of impacted maxillary central incisors: A retrospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2022; 161:548-556. [DOI: 10.1016/j.ajodo.2020.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/01/2022]
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Rédua RB, Nascimento DD, Minchio ES, Dos Santos LS. Interception and early treatment with rapid maxillary expansion for the impacted maxillary permanent central incisor in children: Two cases report with 5-years follow-up. Int Orthod 2020; 18:603-623. [PMID: 32493625 DOI: 10.1016/j.ortho.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The maxillary central incisor impaction represents a complex challenge in paediatric dentistry practice and may result in aesthetic and functional disharmony. The causes of this condition include physical barriers associated or not with a lack of space making eruption not possible, idiopathic ectopic positioning of the teeth or by trauma, non-coordination in rhizalysis and rhizogenesis between deciduous and successor or tooth shape abnormalities. The incidence of this involvement is quite rare, around 1% of the population. Opening of space through disjunction of the palatal suture is the main treatment proposed to solve this situation and, when necessary, the orthodontic traction assisted by surgery. DESCRIPTION Were presented two cases of maxillary central incisors impaction in children treated with rapid maxillary expansion, alignment and levelling, and a follow-up after 5 years of treatment. RESULTS AND CONCLUSIONS The challenge of these treatments were based on the early treatment in mixed dentition with expansion. The treatment of permanent maxillary central incisor impaction in children enabled excellent periodontal response and post-treatment occlusal stability.
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Cruz RM. Orthodontic traction of impacted canines: Concepts and clinical application. Dental Press J Orthod 2020; 24:74-87. [PMID: 30916252 PMCID: PMC6434671 DOI: 10.1590/2177-6709.24.1.074-087.bbo] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 01/04/2019] [Indexed: 11/21/2022] Open
Abstract
Orthodontic traction of impacted canines stands as a major challenge for Orthodontics. It is a relatively frequent clinical complaint which management, more often than not, requires a multidisciplinary approach. Surgical exposure of the impacted canine, and the complex orthodontic mechanics applied to align the tooth back into the arch, may frequently lead to complications involving supporting tissues, not to mention the long treatment time and high costs imposed to patients. In face of that, it is worth highlighting the relevance of early diagnosis as to intervene efficiently and as soon as possible. This paper presents a review of the main concepts involving prevalence, etiology and classification of impacted canines, and describes the different clinical management options that would help solve the problem. It illustrates the topic by presenting a treatment delivered to a 13 year 7 months old male patient, suffering from a Class II, division 2, left subdivision, malocclusion, associated to a deep bite and a prolonged retention of a primary upper canine caused by the impaction of the permanent tooth. Corrective orthodontic therapy was associated to a rapid maxillary expansion and to the use of a high pull headgear. Impacted canine was submitted to orthodontic traction and correctly positioned back into the arch. This approach proved to be efficient in meeting both functional and aesthetic goals.
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Jiang Q, Yang R, Mei L, Ma Q, Wu T, Li H. A novel approach of torque control for maxillary displaced incisors. Am J Orthod Dentofacial Orthop 2019; 155:860-870. [PMID: 31153507 DOI: 10.1016/j.ajodo.2017.11.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/28/2022]
Abstract
Effective torque control is crucial for the successful treatment of impacted incisors; however, torque control is often a challenge with the use of conventional bracket systems, especially when the adjacent teeth require opposite torque managements. A novel approach of torque control for adjacent anterior teeth is introduced in this case report. A 12-year-old boy had an impacted maxillary right central incisor with the adjacent teeth severely displaced. The treatment plan was to regain space and pull the impacted incisor into the dentition. An upper removable appliance was first used to regain space for the impacted central incisor, followed by a spontaneous eruption of the impacted incisor. Subsequently, fixed appliances were bonded to level and align the dentition. However, the crown of the maxillary right central incisor was found to be tipped lingually, while the maxillary right lateral incisor was tipped labially. Traditional torque control, including torque bend and the use of a Warren spring, were first used for the correction, but they were ineffective due to the overlap of the root apex of the maxillary central incisor and lateral incisor. After the roots were separated with a V-shaped curve, auxiliary brackets were bonded on the gingival one-third areas of the maxillary incisors and canine with nickel-titanium wires used for the torque control. This approach of using the auxiliary brackets and wires was demonstrated to be efficient and effective in the torque control of adjacent anterior teeth with opposite torque control requirements. The final result and the 2-year follow-up records demonstrated the proper torque of anterior teeth and good and stable dental and profile esthetics.
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Affiliation(s)
- Qian Jiang
- Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Ren Yang
- Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Li Mei
- Discipline of Orthodontics, Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Qiaoling Ma
- Orthodontics Department, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Tuojiang Wu
- Lan Cheng Dental Clinic, Yunnan, People's Republic of China
| | - Huang Li
- Orthodontics Department, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China.
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Lyu J, Lin Y, Lin H, Zhu P, Xu Y. New clues for early management of maxillary impacted central incisors based on 3-dimensional reconstructed models. Am J Orthod Dentofacial Orthop 2018; 154:390-396. [PMID: 30173842 DOI: 10.1016/j.ajodo.2017.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The objective of this study was to provide new clues for the prevention and early management of root dilacerations in impacted maxillary central incisors. METHODS Cone-beam computed tomography images of 108 patients with unilateral impacted maxillary central incisors were obtained and reconstructed into 3-dimensional models. Crown direction, crown height, root length, bone thickness, and position and angle of root dilaceration were measured in the sagittal-view sections. K-value, defined as the ratio between the available length of the direct root and the ideal length of the direct root, was proposed, and the relationships between K-values with root dilacerations were studied. Root development of the contralateral erupted maxillary incisor was also assessed. Independent t test, chi-square test, and 1-way analysis of variance were used for data analysis. RESULTS Root dilacerations occurred when the K-values were 0.16 to 0.19 (palatal impaction), 0.25 to 0.53 (labial impaction), and 0.69 to 0.75 (nasal impaction). The position and angle of root dilacerations were different among nasal, labial, and palatal impactions (P <0.01). K-values and positions of root dilacerations among nasally, labially, and palatally impacted incisors were in descending order, respectively. Retarded root formation was noted in the impacted incisors compared with the contralateral incisors (P <0.001). CONCLUSIONS Nasal, labial, and palatal impacted incisors had different patterns of root dilacerations. Analyses of crown direction and K-value may aid in evaluating root dilacerations at early dental ages and facilitating early intervention of impacted incisors.
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Affiliation(s)
- Jiahong Lyu
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yi Lin
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Han Lin
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Ping Zhu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yue Xu
- Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.
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Singh H, Kapoor P, Sharma P, Dudeja P, Maurya RK, Thakkar S. Interdisciplinary management of an impacted dilacerated maxillary central incisor. Dental Press J Orthod 2018; 23:37-46. [PMID: 30088564 PMCID: PMC6072448 DOI: 10.1590/2177-6709.23.3.037-046.oar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/02/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tooth dilacerations are dental anomalies characterized by an abrupt deviation in the longitudinal axis of a tooth. They may occur either in the crown, between the crown and root, or in the root. Although not so common, impacted maxillary incisors exhibiting root dilaceration pose a diagnostic and treatment challenge to the clinician. DESCRIPTION This case report describes the management of a horizontally impacted and dilacerated maxillary central incisor in a 12-year-old girl. Cone-beam computed tomographic scans were used to accurately localize the position of the dilacerated tooth, and to assess the extent of root formation and degree of dilaceration present in the root. Treatment included surgical exposure and orthodontic traction, followed by root canal treatment and apicoectomy. RESULTS Through a meticulously planned interdisciplinary approach, the impacted dilacerated central incisor was properly aligned and demonstrated good stability after the long-term follow-up. CONCLUSION Taking into consideration the concerns and expectations of the patient, communicative feedback between the oral surgeon, orthodontist and endodontist helped achieving successful esthetic, structural and functional outcome in the present case.
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Affiliation(s)
- Harpreet Singh
- ESIC Dental College and Hospital, Department of Orthodontics and Craniofacial Orthopedics (New Delhi, India)
| | - Pranav Kapoor
- ESIC Dental College and Hospital, Department of Orthodontics and Craniofacial Orthopedics (New Delhi, India)
| | - Poonam Sharma
- ESIC Dental College and Hospital, Department of Orthodontics and Craniofacial Orthopedics (New Delhi, India)
| | - Pooja Dudeja
- ESIC Dental College and Hospital, Department of Conservative Dentistry and Endodontics (New Delhi, India)
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Sun H, Hu R, Ren M, Lin Y, Wang X, Sun C, Wang Y. The treatment timing of labial inversely impacted maxillary central incisors: A prospective study. Angle Orthod 2016; 86:768-774. [PMID: 26938954 PMCID: PMC8600833 DOI: 10.2319/083015-584.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 01/01/2016] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVE To determine the timing of treatment for the labial inversely impacted maxillary central incisors. METHODS Twenty-eight patients (mean age, 8.2 years) with labial inversely impacted maxillary central incisors were divided into early-treated and later-treated groups according to their dental age. All of the patients were treated with a combination of surgery and orthodontic traction using the Guide rod appliance. Cone-beam computed tomography images were taken immediately after treatment for assessing the root morphology, root length, and alveolar bone loss. Sagittal slices were evaluated at the widest labial-lingual width of the tooth in the axial view. All variables were evaluated by Simplant 13.0 software (Materialise Dental NV, Leuven, Belgium). RESULTS The rank sum test indicated that the root length of two groups showed a statistically significant difference between the impacted and homonym tooth, with a shorter length in the impacted tooth (P < .05). The D-value (difference of root length between the impacted and homonym tooth) and alveolar bone loss on the labial side of the impacted incisor are significantly less in the early-treated groups when compared with the later-treated groups (P < .05). Spearman rank correlation analysis showed a statistically positive association between the treatment timing and D-value (r = .623, P < .05). The chi-square test for morphology of root apex indicated that the incidence of the root-apex-directed labial side is significantly higher in the later-treated groups when compared with the early-treated groups. CONCLUSION The labial inversely impacted maxillary central incisors should be treated early to promote root development by achieving a better morphology of root apex, thus reducing the risk of alveolar bone loss on the labial side.
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Affiliation(s)
- Hao Sun
- Resident Doctor, Department of Orthodontics, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rongdang Hu
- Professor, Department of Orthodontics, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Manman Ren
- Postgraduate Student, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Lin
- Attending Physician, Department of Stomatology, People’s Hospital of Lishui, Lishui, Zhejiang, China
| | - Xiuying Wang
- Resident Doctor, Department of Orthodontics, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chaofan Sun
- Resident Doctor, Department of Orthodontics, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi Wang
- Resident Doctor, Department of Orthodontics, School of Stomatology, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Shi X, Xie X, Quan J, Wang X, Sun X, Zhang C, Zheng S. Evaluation of root and alveolar bone development of unilateral osseous impacted immature maxillary central incisors after the closed-eruption technique. Am J Orthod Dentofacial Orthop 2015; 148:587-98. [PMID: 26432314 DOI: 10.1016/j.ajodo.2015.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Xiangru Shi
- Postgraduate student, Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoyan Xie
- Resident, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Junkang Quan
- Resident, Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaozhe Wang
- Resident, Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiangyu Sun
- Resident, Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Chenying Zhang
- Resident, Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shuguo Zheng
- Professor, Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.
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Almuzian M, Freel J, Cross N, Gardner A. A novel approach for treatment of the impacted maxillary incisor. J Orthod 2015; 42:144-52. [PMID: 25816243 DOI: 10.1179/1465313315y.0000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This case report demonstrates a novel treatment approach to deal with a severely rotated and impacted upper central incisor in an adolescent patient. A precision custom-made gold attachment was fabricated from a prototype using cone beam computerized tomograph (CBCT) scan data and then used to align and de-rotate the impacted central incisor.
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Sun H, Wang Y, Sun C, Ye Q, Dai W, Wang X, Xu Q, Pan S, Hu R. Root morphology and development of labial inversely impacted maxillary central incisors in the mixed dentition: A retrospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2014; 146:709-16. [DOI: 10.1016/j.ajodo.2014.07.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 11/29/2022]
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20
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Vila Real LAS, Ramos AL. Root redirection after an upper central incisor traction with incomplete apex dilaceration: Case report with CBCT images. J World Fed Orthod 2014. [DOI: 10.1016/j.ejwf.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chandhoke TK, Agarwal S, Feldman J, Shah RA, Upadhyay M, Nanda R. An efficient biomechanical approach for the management of an impacted maxillary central incisor. Am J Orthod Dentofacial Orthop 2014; 146:249-54. [PMID: 25085308 DOI: 10.1016/j.ajodo.2013.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/01/2013] [Accepted: 09/01/2013] [Indexed: 11/29/2022]
Abstract
Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients.
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Affiliation(s)
- Taranpreet K Chandhoke
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn.
| | - Sachin Agarwal
- Resident, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Jonathan Feldman
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | | | - Madhur Upadhyay
- Assistant professor, Division of Orthodontics, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Conn
| | - Ravindra Nanda
- Professor and head, Department of Craniofacial Sciences, Alumni Endowed Chair, School of Dental Medicine, University of Connecticut, Farmington, Conn
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Rizzatto SMD, de Menezes LM, Allgayer S, Batista EL, Freitas MPM, Loro RCD. Orthodontically induced eruption of a horizontally impacted maxillary central incisor. Am J Orthod Dentofacial Orthop 2013; 144:119-29. [DOI: 10.1016/j.ajodo.2012.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 10/26/2022]
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Wei YJ, Lin YC, Kaung SS, Yang SF, Lee SY, Lai YL. Esthetic periodontal surgery for impacted dilacerated maxillary central incisors. Am J Orthod Dentofacial Orthop 2012; 142:546-51. [PMID: 22999678 DOI: 10.1016/j.ajodo.2011.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 07/01/2011] [Accepted: 07/01/2011] [Indexed: 10/27/2022]
Abstract
Clinicians do not frequently see impacted dilacerated maxillary incisors in their patients. When they do, there are several diagnostic and management challenges for correcting root dilacerations. An unfavorable esthetic outcome might occur as a result of soft-tissue complications during surgical eruption procedures. We present 2 patients with an impacted and dilacerated maxillary central incisor. Computed tomography scans with 3-dimensional reformation were used to accurately assess the positions of the dilacerated teeth, the degree of dilaceration, and the stage of root formation. The therapy primarily involved 2-stage crown exposure surgery combined with orthodontic traction. An apicoectomy was performed on 1 dilacerated tooth; the other exhibited pulp vitality. This article highlights the periodontal surgical strategies for the esthetic management of inverted crowns. Through periodontal plastic surgery and interdisciplinary cooperation, the impacted dilacerated central incisors were properly aligned, and successful esthetic results were achieved.
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Affiliation(s)
- Yu-Ju Wei
- Division of Periodontology, Department of Stomatology, Taipei Veterans General Hospital, Taiwan.
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Ho KH, Liao YF. Pre-treatment radiographic features predict root resorption of treated impacted maxillary central incisors. Orthod Craniofac Res 2012; 15:198-205. [PMID: 22812442 DOI: 10.1111/j.1601-6343.2012.01545.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine independent predictors of root resorption for surgical-orthodontic treatment of impacted maxillary central incisors. SETTING AND SAMPLE POPULATION The Department of Dentistry at Show Chwan Hospital, Changhua, Taiwan. Eighty patients with unilateral osseous-impacted maxillary central incisors receiving a surgical-orthodontic treatment. MATERIAL AND METHODS This is a retrospective observational study. Root resorption and its predictors were abstracted from patients' charts, pre-treatment cephalometric radiographs, and post-treatment periapical radiographs. Predictors included demographics, treatment duration, crown angle, crown height, crown depth, and root dilacerations. RESULTS The patients' mean age was 9.2 ± 2.3 years (6.4-20.6 years), and 60% were females. Impacted maxillary central incisors had greater root resorption than naturally erupted contralateral incisors (Δ = -2.8 mm, p < 0.001). Independent predictors of root resorption for impacted maxillary central incisors were shown by linear regression analysis to be crown height (β = -0.2, p < 0.01), crown depth (β = -0.3, p = 0.001), treatment duration (β = 0.2, p < 0.01), and root dilacerations (β = 3.1, p = 0.001). CONCLUSIONS Impacted maxillary central incisors had greater root resorption during surgical-orthodontic treatment than their naturally erupted contralateral incisors. Predictors of a greater root resorption were highly and deeply impacted incisors, longer treatment, and root dilacerations. These predictors may help to inform patient and family counseling before treatment.
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Affiliation(s)
- K H Ho
- Department of Dentistry, Show Chwan Hospital, Changhua, Taiwan
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