Indexada y registrada en. Ustasalud ;]. Root resorption associated with orthodontic tooth movement: A systematic review. Am J Orthod Dentofacial Orthop. Physical properties of root cementum: Part Continuous vs intermittent controlled orthodontic forces on root resorption.
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This case describes the treatment of Class II malocclusion in a patient missing one of the maxillary central incisors due to traumatic impaction. The treatment approach consisted in the extraction of the remaining maxillary central incisor, followed by diastema closure and re-anatomization of lateral incisors into central incisors. The results obtained were considered satisfactory concerning occlusal, aesthetic and functional aspects.
This therapeutic approach may be used as an alternative for similar cases. Dental Class II malocclusion is one of the most prevalent orthodontic problems. This type of malocclusion may present different clinical features, such as protruded upper teeth, retruded lower teeth, or even a combination of both Saikoski et al. Several therapeutic approaches may be used to treat this type of malocclusion, among which are distalization of teeth with intra- and extraoral appliances and dental extractions Hematpour et al.
In the latter, the teeth most commonly selected are premolars. The selection of premolars is based on the middle position of such teeth in the dental arch and their size, as well as the existence of two premolars bilaterally in the hemiarches. However, there are given clinical situations in which the extraction of premolars is not possible; in these cases, other teeth such as molars, incisors, and canines might be involved Livas et al.
When maxillary central incisors are compromised by extensive decay beyond the cementoenamel junction , fracture, ankylosis, or inappropriate position, their atypical extraction is considered an acceptable alternative Janson et al. In this case, several factors should be considered, such as: facial biotype, tooth size and shape, type of occlusion, gap to be closed and root length Sabri, Based on the exposed, this study aims to report the treatment of Class II malocclusion in a patient missing the maxillary central incisor by extracting the contralateral central incisor.
The results achieved showed correction of malocclusion with aesthetic and functional gains. An Afro-Caucasian female aged The patient was in good general and oral health and presented history of caries and satisfactorily dental restorations. Clinically, the feature that most stood out was the absence of her maxillary left central incisor tooth According to the extra-oral examination and measurements in the lateral teleradiography, the patient had brachyfacial features SN.
GoGn of Gn of The intraoral examination revealed the presence of lower anterior crowding with cast discrepancy of The radiographic examinations showed that tooth 21 was unerupted and poorly positioned in the buccal and horizontal directions at the height of the anterior nasal spine. The upper and lower third molars were also poorly positioned and impacted.
No other abnormality was verified Fig. The lateral teleradiography elucidates the position of tooth Treatment Alternatives. Some alternatives for the treatment of this malocclusion are described below:. This was the selected option reported herein. Treatment Progress. The treatment selected was the extraction of the right and left maxillary central incisors, followed by mesialization and reanatomization of maxillary lateral incisors, canines, and premolars into central incisors, lateral incisors, and canines, respectively, leading the molars to Angle Class II relationship.
Initially, the extraction of tooth 21 unerupted was requested so the treatment could be started. The orthodontic treatment began by cementing the transpalatal bar between teeth 16 and 26 in order to anchor the verticalization of teeth 17 and Then, the extraction of the maxillary right incisor 11 was requested, considering its crown was worn and used as a temporary crown. The initial wires used were 0. Later, the thermoactivated rectangular 0.
As the edentulous space was reduced, the re-anatomization of the maxillary anterior teeth 12 and 22 was performed. The brackets were rebonded to such teeth before the mesialization movement of all anterior maxillary teeth. The 0. After mesialization, the re-anatomization of maxillary canines and premolars was performed. A slice was made in the mandibular teeth for better placing the incisors relative to the symphysis, considering the lower incisors were buccally oriented as shown in the IMPA measurement of NB of Two years after the beginning of treatment, the intercuspation procedure was started.
At the end of intercuspation and occlusal adjustment, the fixed appliance was removed and the retainers were installed. A fixed hygienic retention for maxillary teeth was installed in association with a removable retention for the mandibular arch Wraparound , for an intended use of 24 months. Treatment Results. The following results were achieved: relationship of an upper tooth occluding between two lower teeth, reduction of biprotrusion and overjet, closure of maxillary anterior diastemas Figs.
The radiographic follow-up showed no significant absorption in the roots of the teeth due to orthodontic movements. The cephalometric Point A was found to be positioned posteriorly, leading to profile improvements Fig. Finally, Figure 7 shows a harmonious gingival contour that contributes to acceptable gingival aesthetics.
The lower incisors underwent lingual inclination, which improved their relationship with the middle of the symphysis. Note the position of point A. Dental eruption is a physiological process that should be impeccably precise.
In this case report, the patient presented the left maxillary central incisor 21 with dilacerated root and crown in horizontal position, which prevented traction. The extraction of premolars is widely accepted by orthodontists in the treatment of Angle Class II malocclusion, for it allows obtaining a satisfactory occlusal and aesthetic outcome Zentner et al. In this report, maxillary protrusion might be compensated by extracting maxillary premolars and the left central incisor, replacing the latter with an osseointegrated implant and fixed prosthesis with an artificial tooth.
However, the patient declined this option due to the number of dental extractions and the financial cost. Another option proposed and accepted by the patient was the extraction of the right and left maxillary incisors, followed by the re-anatomization of lateral incisors into central incisors, canines into lateral incisors, and premolars into canines. The main advantages of this approach are preventing osseointegrated implant installation, preserving two natural teeth in the maxillary arch upper first premolars , and reducing the time and total cost of orthodontic treatment.
Reducing treatment time is one of the approaches for preventing the occurrence of external root resorption, which is a major sequel from orthodontic movement in association with other factors.
In addition to cost, another disadvantage of the treatment with osseointegrated implants is that the patient of the present study was a young adult, which means lack of growth in the implant installation area. Another difficulty would lie in controlling the gingival contour in the implant region without the existence of shadows, as this is an aesthetically demanding area Janson et al.
In this case, the option of extracting the maxillary central incisors was a treatment alternative for Class II malocclusion, because the inappropriate position of tooth 21 did not allow its traction. In order to achieve a satisfactory functional and aesthetic result, several issues had to be resolved. The maxillary lateral incisors had thin roots, which implicated in more cautious and limited movements to prevent the inclination of roots during displacement; otherwise, re-anatomization would be challenging and there would be loss of interdental papilla, and consequently the formation of black triangles.
This situation was managed with the use of bends in the finishing arch or angulations in the brackets, in order to create root parallelism. However, the patient decided to have the appliance removed before the end of treatment, when the crown was still inclined, making it difficult to reshape the maxillary lateral incisor, thus highlighting the black triangle due to the lack of interdental papilla Figs.
A papillary reconstruction was performed by means of an envelope flap and a graft of attached gingiva in the region between the maxillary lateral incisors, after root parallelism.
This procedure was refused by the patient. A Panoramic; B Periapical radiographs of maxillary incisors; C Periapical radiographs of mandibular incisors. The extrusion of maxillary canines and the intrusion of maxillary premolars would be performed for a correct gingival height, but the treatment ended early.
The appropriate aesthetic treatment should include tooth whitening, porcelain veneers, and gingival plastic surgery Ishihara et al.
Space closure through maxillary canines replacing the lateral incisors provides a satisfactory result, but leads to major occlusal changes Ishihara et al. The maxillary canine is larger in the buccal palatal direction than the maxillary incisor. Therefore, wearing the palatal surface is required to avoid premature contacts with the mandibular incisors Janson et al. In addition, the labial surface should be worn to become flatter.
Studies have shown that wearing the palatal and labial surfaces does not damage either dentin or pulp Janson et al. Thus, the cusp tip and the labial surface were reduced to form a flat surface. The angles were rounded in the mesial and distal aspects to complete the re-anatomization of maxillary canines. Canines are responsible for disocclusion during right and left lateral movements. In the present case, this function was not performed due to the mesialization towards the region of the maxillary incisor.
Thus, disocclusion was adjusted to be performed by a group of teeth, which is also considered satisfactory. In parallel, individual torques, extrusions, and dental rotations were performed to ensure proper mandible lateralization movements.
A radiographic follow-up should be conducted, as a long-term problem may occur, meaning the root volume of the premolar is smaller than that of the maxillary canine Ishihara et al. This type of mechanics is a potential therapeutic option, considering the biological limits and periodontal structures. The treatment plan focused on the impossibility of traction of the maxillary central incisor, which was then replaced by adjacent teeth occupying the gap left by the extractions.
This procedure was chosen because the patient refused to have an osseointegrated implant and fixed prosthesis with an artificial tooth. The atypical extraction of a maxillary central incisor is not a routine protocol in orthodontics. The re-anatomization of maxillary anterior teeth and gingival plastic surgery are required for a satisfactory aesthetic result. Deryckere, F.
Treatment of a congenitally missing upper lateral incisor with an implant. El Refaei, A. Treatment of a complex malocclusion in a growing skeletal Class II patient. Hematpour, S. Milwaukee, 25 2 , Iseri, H. Continued eruption of maxillary incisors and first molars in girls from 9 to 25 years, studied by the implant method.
Ishihara, Y. Extraction of the lateral incisors to treat maxillary protrusion: quantitative evaluation of the stomatognathic functions. Angle Orthod.
Browsing Odontología: Ortodoncia y Ortopedia Maxilar by Subject
El tratamiento interceptivo requiere largo seguimiento y no elimina la necesidad de tratamiento correctivo. ABSTRACT : The aim was to determine the benefit of implementing interceptive orthodontic clinics in infant patient analyzing recent literature about it. We conducted a systematic review of the literature by searching PubMed, SciELO and Cochrane Library for the past 10 years in response to the question: "In children with dentoalveolar malocclusions is it beneficial to implement interceptive orthodontics or is it better to apply a therapy at the end of growth? We used inclusion and exclusion criteria to find the highest-level evidence.
This case describes the treatment of Class II malocclusion in a patient missing one of the maxillary central incisors due to traumatic impaction. The treatment approach consisted in the extraction of the remaining maxillary central incisor, followed by diastema closure and re-anatomization of lateral incisors into central incisors. The results obtained were considered satisfactory concerning occlusal, aesthetic and functional aspects. This therapeutic approach may be used as an alternative for similar cases.