Treatment of ankylosis of the mandibular first molar with orthodontic traction immediately after surgical luxation

Orthodontic alignment of ankylosed teeth with aid of surgical luxation: Case series

BACKGROUND

Identification of tooth ankylosis before comprehensive orthodontic treatment can be challenging. This case series illustrates different presentations of tooth ankylosis, the importance of early diagnosis, the use of surgical luxation to aid orthodontic alignment of ankylosed teeth and its sequelae.

CASE PRESENTATION

All three cases were adolescents: a 14-year-old girl with a highly placed upper left lateral incisor and history of general anaesthesia; a 14-year-old boy with an impacted upper right first premolar and history of dental trauma; and a 13-year-old girl with an infraoccluded upper left central incisor with history of replantation due to avulsion. Iatrogenic malocclusion developed from attempts to align these ankylosed teeth. Subsequently, surgical luxation was performed, and the ankylosed teeth were successfully aligned. However, it was associated with pulp calcification, root resorption and recurrence of ankylosis.

CONCLUSION

Surgical luxation and orthodontic alignment of ankylosed teeth can be considered a useful short-term solution to delay the need of surgical removal and teeth replacement.

Forced eruption in impacted teeth: analysis of failed cases and outcome of re-operation

BACKGROUND

Forced eruption of an impacted tooth usually requires surgical and orthodontic interventions to successfully bring the tooth into the dental arch. The clinical time required for a forced eruption is difficult to predict before treatment begins and success rates are affected by several factors before and after an eruption. This study was conducted to identify factors that affect the success of forced eruption, the duration of orthodontic treatment of impacted teeth, and the reasons for re-operation and forced eruption failure in a various teeth and cases.

METHODS

In this retrospective study, the records regarding the forced eruption of 468 teeth in 371 patients from June 2006 to May 2020 at the Advanced General Dentistry Department of Yonsei University Dental Hospital were initially examined. The records of 214 teeth in 178 patients who completed orthodontic treatment were included in the analysis. Data on patient demographics, tooth characteristics, orthodontic treatment duration, re-operations, and failures were collected from electronic medical records.

RESULTS

There was a significant difference in age between the success and failure forced eruption. Factors significantly affecting treatment duration were apex formation, position, rotation, and re-operation. Re-operation had a 96% success rate. The average orthodontic treatment duration was 29.99 ± 16.93 months, but the average orthodontic treatment duration for teeth that undergone re-operation was 20.36 ± 11.05 months, which was approximately 9 months shorter. Additionally, there was an interaction effect between rotation and re-operation on the duration of orthodontic treatment. The causes for failure of forced eruption in 6 cases were ankyloses (3 cases), incomplete alignment with the normal dental arch (2 cases), and a significant deviation in the impacted tooth's location (1 case).

CONCLUSIONS

To increase the success rate of forced eruption, age should be considered as a priority, and in order to predict the treatment period, the apex formation status, position in the arch, and rotation should be considered in addition to age. When determining re-operation, considering factors such as ankylosis, root curvature, and apex formation can help in the success of orthodontic treatment.

Eyes wide open to avoid misleading diagnosis and treatment planning

INTRODUCTION

The treatment of impacted and transposed teeth is a challenge for clinical practice. A precise assessment of the relative position of the transposed tooth could lessen the risks of adverse effects, such as root resorption and periodontal problems.

DESCRIPTION OF THE CASE

An 18-year-old patient went to the Orthodontic Department of the Federal University of Juiz de Fora, Brazil for a re-evaluation of the orthodontic treatment to which she had been receiving since the age of 12. Attempted traction of an impacted maxillary canine resulted in root resorption, marked mobility and alteration in the position of adjacent teeth as well as loss of alveolar bone in the anterior region of the maxilla. This tooth was not only partially transposed, but it also had ankylosis, external and internal tooth resorption, which indicated the need for tooth extraction. A change was made to the treatment plan, with the extraction of the canine, bone graft and mesial movement of the posterior teeth.

RESULTS

All the spaces were closed at the end of treatment, with normal overbite and overjet. At the follow-up, the teeth position, the shape of dental arches, disocclusion guides and dental occlusion were preserved. The bone graft in the maxilla showed height and mineral density stability.

CONCLUSION

The presence of the maxillary permanent canines in the dental arch is important for both aesthetics and a functional occlusion. However, despite the importance of their maintenance in the arch, it is well advised that each case be analysed individually.

Camouflage Correction of Skeletal Class III Severe Open Bite with Tooth Ankylosis Treated by Temporary Anchorage Devices: A Case Report

Tooth ankylosis is a disorder characterized by the fusion of tooth and alveolar bone. This case report describes the treatment of a severe open bite due to tooth ankylosis. A 14-year-old female patient with a chief complaint of masticatory dysfunction was diagnosed with skeletal Class III severe anterior open bite and tooth ankylosis. She visited our university hospital with a chief complaint of an anterior open bite. After the surgical luxation of the ankylosed maxillary right central incisor, the tooth was orthodontically retracted using a nickel-titanium wire. The right mandibular lateral incisor and canine were luxated and retracted using intermaxillary elastics from a temporary anchorage device (TAD), which was inserted in the opposite jaw. During the treatment, skeletal Class III malocclusion deteriorated due to anterior growth of the mandible. Therefore, TADs were inserted into the retromolar pad on both sides of the mandible and retracted into the mandibular dental arch. Although the mandibular right canine was luxated several times, it could not be brought to the occlusal line, and was thus extracted; the extraction space was replaced with a prosthesis. Consequently, a normal overjet and overbite with a straight profile were achieved. Extrusion of ankylosed teeth by intermaxillary elastics from a TAD is a valid treatment option for patients with severe open bites.

Treatment for critically impacted maxillary canines: Clinical versus scientific evidence - A systematic review

BACKGROUND

Critically impacted maxillary canines are prone to fail to respond to conventional surgical exposure and orthodontic traction. Correct identification of a critical impaction requires enhanced diagnosis modalities and might lead to incorporating alternative surgical strategies in the treatment plan. Predictability of techniques such as apicotomy or tooth autotransplantation is, however, yet to be determined. The objective of this study was to systematically review treatment perspectives for critically impacted maxillary canines.

METHODS

A systematic review of the available literature until april 2020 was conducted using an electronic search in Embase, Cochrane Central, Web of Science and PubMed databases. Randomised and non-randomised studies investigating treatment options and treatment outcome for buccally and/or palatally critically impacted maxillary canines were considered for the review. Information recorded concerned study design and setting, participants' characteristics and details regarding the type of intervention, types of outcomes measured and follow-up time. The included studies received a methodological quality scoring and risk of bias analysis according to a tool suggested by Murad et al (2018).

RESULTS

Five studies were included in the quality analysis, all case series. The included studies enrolled a total of 302 patients and counted 346 critical maxillary canine impactions. Apicotomy and autotransplantation were listed as potential surgical approaches with surgical outcome presented for both surgical strategies. Adequate esthetical and/or functional outcomes were reported in most of the included studies. According to the quality assessment tool used, the reviewed studies scored medium on the proposed scale.

DISCUSSION

Literature featuring protocols for identifying and treating critical maxillary canine impaction only consists of case series and case reports, which provide low level of evidence. The rather good results reported by the reviewed studies must be put into perspective as the methodology of these studies was insufficient and potential bias was identified. Comprehensive clinical research is needed to further investigate treatment options and form a basis for clinical guidelines.

Orthodontic treatment of a severe combined anterior and posterior open bite case, involving ankylosis and eruption disturbances in late adolescence

Treatment of a combined anterior and posterior open bite case is a demanding orthodontic procedure that requires, in many cases, a multidisciplinary approach. Disturbances in the time or pattern of permanent teeth eruption can often cause or aggravate these clinical conditions, that once established can affect the occlusion, the mastication, the speech, and the oral health quality of life index of such a patient. This article describes the orthodontic treatment of a teenager with severe anterior and posterior open bite, a unilateral posterior crossbite and serious mastication problems. Proper diagnosis, treatment planning, and mechanotherapy used, resulted in excellent orthodontic outcome, greatly improving all aspects of the patient’s initial concerns and the clinician’s goals.