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Pinheiro IS, Campos MJDS, Reis LG, Mota Júnior SL, Vitral RWF. Eyes wide open to avoid misleading diagnosis and treatment planning. J Orthod 2023; 50:385-390. [PMID: 35369788 DOI: 10.1177/14653125221088888] [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: 11/15/2022]
Abstract
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.
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Turley PK. The management of mesially inclined/impacted mandibular permanent second molars. J World Fed Orthod 2020; 9:S45-S53. [PMID: 33023732 PMCID: PMC7532936 DOI: 10.1016/j.ejwf.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
Mesially impacted mandibular second molars are a common occurrence in orthodontic practices, especially those using the lingual arch or lip bumper for alleviating anterior crowding. Horizontally impacted second molars, on the other hand, occur so infrequently that most practitioners have limited experience in treating such a patient. Because of this there is little consensus on the management of these cases. As opposed to vertically impacted molars that may be associated with ankylosis or other factors preventing eruption, the mesially angulated, horizontally impacted mandibular second molar usually has eruption potential, because its impaction is more commonly due to lack of space and/or abnormal eruption path. Hence, orthodontic uprighting shows the most promise and can commonly be done without extracting the third molar or surgically exposing the impacted second molar. Modern clinicians have at their disposal a myriad of biomechanical choices that can be used to successfully reposition these teeth and enable finishing with an optimal occlusion.
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Affiliation(s)
- Patrick K Turley
- Professor Emeritus, Sections of Orthodontics and Pediatric Dentistry, School of Dentistry, University of California at Los Angeles, Los Angeles, CA
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Okihara H, Ono T. Correction of bilateral heavily impacted second molar with improved super-elastic nickel-titanium alloy wires. Am J Orthod Dentofacial Orthop 2020; 158:114-125. [PMID: 32600748 DOI: 10.1016/j.ajodo.2019.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/08/2019] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
Impaction and an abnormal eruption of a second molar occur because of a lack of retromolar space, premature eruption of the mandibular third molar, and ankyloses. The prognosis must be carefully considered when extracting a damaged permanent tooth. In addition to extraction for orthodontics, this enables the establishment of an effective force system to align the impacted tooth. A 21-year-old woman exhibited maxillary anterior crowding, deviation of the maxillary midline, and deeply impacted mandibular second molars bilaterally. The molar relationship was Class II. The cephalometric analysis demonstrated a skeletal Class I relationship (ANB angle, 1.4°); maxillary and mandibular incisors were lingually inclined. Cone-beam computed tomography images indicated that root resorption, caries, and periodontitis were absent in all mandibular molar. Mandibular second premolars were extracted to relieve crowding and achieve Class I molar relationships. The second molars moved mesially on both sides, and there were no signs of ankylosis. We used improved super-elastic nickel-titanium alloy wire (ISW) to upright the mesioangular second molars. We heat-treated the anterior portion of the ISW, including the first molar area, to increase wire stiffness; the posterior portion of the ISW, including the impacted second molar area, remained untreated to ensure that its super-elasticity was preserved. We alleviated crowding, corrected the maxillary midline, and created ideal occlusion with Class I relationship. This case shows that the alignment of a deeply impacted tooth with a heat-treated ISW, combined with voluntary adjustment of wire stiffness, can be a simple and useful treatment option for adult patients.
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Affiliation(s)
- Hidemasa Okihara
- Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Takashi Ono
- Department of Orthodontic Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Jiang S, Liu T, Wu G, Li W, Feng X, Pathak JL, Shi J. BMP2-Functionalized Biomimetic Calcium Phosphate Graft Promotes Alveolar Defect Healing During Orthodontic Tooth Movement in Beagle Dogs. Front Bioeng Biotechnol 2020; 8:517. [PMID: 32548104 PMCID: PMC7272671 DOI: 10.3389/fbioe.2020.00517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Grafting of biomaterial in alveolar defect facilitates bone healing and orthodontic treatment. BMP2-functionalized biomimetic calcium phosphate (BioCaP) graft had shown excellent bone defect healing potential in many preclinical studies. In this study, we aimed to investigate the influence of BioCaP graft on surgical alveolar bone defect healing during orthodontic tooth movement (OTM) in beagle dogs. Methods: Nine Beagle dogs were randomly assigned to three groups: control, deproteinized bovine bone (DBB), and BioCaP. The maxillary second premolars were protracted into the defects of the extracted maxillary first premolar for 8 weeks. The rate of OTM, alveolar remodeling and bone defect healing were evaluated by histology, histomorphometry, and cone beam computed tomography (CBCT) imaging. Periodontal probing depth was analyzed. Gingival cervicular fluid was collected at week 4 and 8, and the IL-1β level was measured by ELISA. Results: The histological sections of the bone defect showed more newly formed bone in the BioCaP group. The percentage of new bone formation in the BioCaP group was 1.61-, and 1.25-fold higher compared to the control and DBB group, respectively. After 8 weeks of OTM, the resorption rate of BioCaP was 1.42-fold higher compared to DBB. The root resorption index in the DBB group was 1.87-, and 1.39-fold higher compared to the control and BioCaP group, respectively. CBCT images showed 1.92-, and 1.36-fold higher bone mineral density in the BioCaP group compared to the control and DBB group, respectively. There was no significant difference in OTM among the three groups. The distance between the enamel cementum and the crest of the alveolar ridge in the control group was 1.45-, and 1.69-fold higher compared to DBB and BioCaP group, respectively. Periodontal probing depth at week 8 was reduced in the BioCaP group compared to the control. IL-1β concentration in the gingival cervicular fluid was significantly lower in the BioCaP group compared to the control group at week 4 and 8. Conclusion: BioCaP graft robustly promoted bone regeneration and alveolar bone defect healing without affecting OTM. BioCaP graft caused less alveolar bone recession and root resorption of traction tooth with favorable periodontal attachment level indicating that BioCaP as a bioactive and functional bone filling material for alveolar bone defects during orthodontic treatment.
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Affiliation(s)
- Shijie Jiang
- Department of Orthodontics, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China
| | - Tie Liu
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China.,Department of Oral Implantology, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre of Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam and University of Amsterdam, Amsterdam, Netherlands
| | - Wen Li
- Department of Orthodontics, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China
| | - Xiaoxia Feng
- Department of Orthodontics, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China
| | - Janak L Pathak
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiejun Shi
- Department of Orthodontics, The Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Stomatology, Hangzhou, China
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Elshebiny T, Palomo JM, Erian E, Baumgaertel S, Palomo L. Vertical bone augmentation for implant site development: A burgeoning role for orthodontics. Semin Orthod 2019. [DOI: 10.1053/j.sodo.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nucera R, Bellocchio AM, Oteri G, Farah AJ, Rosalia L, Giancarlo C, Portelli M. Bone and cortical bone characteristics of mandibular retromolar trigone and anterior ramus region for miniscrew insertion in adults. Am J Orthod Dentofacial Orthop 2019; 155:330-338. [PMID: 30826035 DOI: 10.1016/j.ajodo.2018.04.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/01/2018] [Accepted: 04/01/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate bone depth, cortical bone thickness, and vestibulolingual bone dimension of the mandibular retromolar trigone and anterior ramus region to evaluate what are its most suitable sites for miniscrew insertion in adults. METHODS The sample included cone-beam computerized tomography (CBCT) records of 60 adult subjects retrospectively evaluated. All CBCT examinations were performed with the use of an i-CAT CBCT scanner (Imaging Sciences International). Each exam was converted into DICOM format and processed with the use of Osirix Medical Imaging software. On reproducible sagittal scan views, bone depth and cortical bone thickness were evaluated on specific lines parallel and at a 45° angle to the occlusal plane, and at 3 mm and at 6 mm distance from it. Vestibulolingual bone dimension was computed in 4 different cross-section scans and at 3 different levels of depth (0, 6, and 11 mm). RESULTS All of the considered insertion sites showed on average more than 10 mm of bone depth. Inferential statistics showed significantly (P <0.05) greater bone depth (+3 mm) in cross-sectional scans parallel to the occlusal plane compared with those at a 45° angle to it. Cortical bone thickness showed average values from 3 mm to 5 mm. Vestibulolingual bone dimension showed a significant (P <0.05) reduction (-10 mm) in the posterior region of retromolar region. No significant differences were found between subjects with and without third molars. CONCLUSIONS The retromolar trigone and anterior ramus region showed enough bone quantity and adequate bone quality for safe miniscrew insertion in adults.
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Affiliation(s)
- Riccardo Nucera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy.
| | - Angela Mirea Bellocchio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Giacomo Oteri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Athena Janan Farah
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Leonardi Rosalia
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Cordasco Giancarlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
| | - Marco Portelli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, School of Dentistry, University of Messina, Messina, Italy
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Jung MH. Asymmetric extractions in a patient with a hopeless maxillary central incisor, followed by treatment with mini-implant anchorage. Am J Orthod Dentofacial Orthop 2018; 153:716-729. [DOI: 10.1016/j.ajodo.2016.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022]
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