Can forces be applied directly to the root for correction of a palatally displaced central incisor with a dilacerated root?

This case report describes the interdisciplinary treatment of an ectopic horizontally placed maxillary right central incisor with severe root dilaceration. The root was distally angulated and entrapped by the root of the maxillary right lateral incisor. The initial force system was aimed at an occlusal displacement and applied to the crown. During the second phase, a button was cemented onto the apex of the impacted tooth. A force from the apex to a temporary anchorage device in the palate moved the root toward the midline. Finally, a root canal and an apectomy were performed and the central incisor could be moved to its ideal position. The treatment generated a normal height of the alveolar bone and an ideal occlusion with a healthy periodontium.

Surgical extrusion with an atraumatic extraction system: A clinical study.

STATEMENT OF PROBLEM: Clinical studies evaluating the feasibility of a novel technique for the surgical extrusion of nonrestorable teeth with subgingival caries are lacking. PURPOSE: The purpose of this clinical study was to investigate the success rate and incidence of biological and technical complications after tooth extrusion with an atraumatic extraction system (AES). MATERIAL AND METHODS: Participants were recruited from 61 consecutive patients initially referred to a specialist oral surgery practice. Fifty-one participants who underwent surgical extrusion with an AES followed by endodontic treatment and coronal restoration could be re-evaluated clinically and radiographically. RESULTS: The mean observation period was 3.1 years (range: 0.8 to 6.5 years). The participants varied in age between 24.8 and 86.3 years. The amount of extrusion was between 2.5 and 5.0 mm (mean 3.2 mm). At recall, 92.2% (47 of 51) of the extruded teeth were considered successful. All extruded teeth were asymptomatic, without clinical signs of inflammation. Percussion appeared normal and did not differ from that of the adjacent teeth, indicating absence of ankylosis. Transient resorption with a slightly altered root contour was detected in 5 of the 51 teeth. Minor reduction of the bone level (less than 10%) was detected in 8 of the 51. In a further 2 teeth, bone loss amounted to 25% and 30%. Periapical periodontitis at recall was seen in 4 of the 51 teeth, and a preexisting periapical lesion healed in 10 of 13. Root perforation was identified in 3 of the 51, and a further 3 of 11 were not available for recall. Thus, the technical complication rate was 9.7% (6 of 62). CONCLUSIONS: The AES may be successfully used for surgical extrusion to save apparently nonrestorable teeth, irrespective of patient age.

Combined orthodontic, surgical, and restorative approach to treat a complicated crown-root fracture in a maxillary central incisor.

This case report shows the treatment of a severe traumatic tooth injury. For the maxillary right central incisor, the trauma was considered a complicated crown-root fracture. The level of the fracture line, the length of the remaining root segment, and the presence and condition of the tooth fragment determined the type of therapy. Traumatized teeth with fractures below the alveolar crest are often considered hopeless. As this report shows, the treatment of a complicated crown-root fracture in the esthetic region can be challenging. Orthodontic extrusion and crown-length surgery were performed to bring the fracture line above the alveolar bone crest. A multidisciplinary approach was required for complete rehabilitation of the traumatized maxillary incisor. Suggestions are made to improve treatment planning of complicated crown-root fractures.

Extrusion of severely impacted mandibular first molar using partial orthodontics and temporary anchorage miniscrews.

BACKGROUND: This study reports a case in which a severely impacted lower first molar was recovered with a combined orthodontic therapy and minimally invasive oral surgery with special focus to patient's aesthetic demands. CASE REPORT: A 12-year- old female patient was complaining delayed eruption of mandibular right first molar. Radiographic exam showed a severe tooth impaction with a close relationship between tooth roots and mandibular nerve. As the patient refused full arches orthodontic treatment, a partial orthodontic approach was projected. During treatment, temporary miniscrews were placed in both upper and lower arches, in order to allow dental movement with maximum anchorage. After a 24 month-therapy the tooth was extruded, so the appliance and the miniscrews were removed. CONCLUSION: The present case shows that severe tooth impaction can be resolved with a combined partial orthodontic- minimally invasive surgical treatment.

Orthodontic Extrusion as Treatment Option for Crown-Root Fracture: Literature Review with Systematic Criteria.

OBJECTIVE: To review the literature searching for a consensus for the choice of orthodontic extrusion as treatment for crown-root fracture. MATERIALS AND METHODS: An electronic search was performed in the databases PubMed, Cochrane Central Register of Controlled Trials and Scopus and a manual search of the Journal Dental Traumatology. RESULTS: Forty articles were found in PubMed and 38 in Scopus and after removal of duplicate sample 51 contained articles. Of these, 48 were excluded for not having orthodontic treatment, no follow-up or follow-up less than 6 months, or not report the presence of crown-root fracture. In manual search in Dental Traumatology 20 articles were found, but none of them met the prerequisites established. So, three articles formed the basis of the study. CONCLUSION: The choice of how to treat orthodontic extrusion of crown-root fracture was effective and stable, without root and periodontal changes. Factors, such as root formation and presence of pulp vitality were decisive for determining the stages of treatment, however, there is no consensus based on scientific evidence about these protocols.

Treatment of an impacted dilacerated maxillary central incisor.

The diagnosis of an impacted incisor with dilaceration refers to a dental deformity characterized by an angulation between the crown and the root, causing noneruption of the incisor. In the past, surgical extraction was the first choice in treating severely dilacerated incisors. The purpose of this case report was to present the correction of a horizontally impacted and dilacerated central incisor through 2-stage crown exposure surgery combined with continuous-force orthodontic traction. The tooth was successfully moved into its proper position. The treatment is discussed, and the orthodontic implications are considered, with a review of the current literature on this topic.

Orthodontic treatment of a unilateral impacted mandibular canine and first premolar: a case report.

BACKGROUND: Few dentists have seen an impacted mandibular canine and first premolar, and there is little information in the literature on the treatment of this rare condition. CASE REPORT: A 13-year-old Japanese male with an impacted mandibular right canine and first premolar was treated orthodontically. We discuss both the surgical and orthodontic options and present the successful orthodontic correction of a unilaterally impacted mandibular canine and first premolar.

Orthosurgical treatment including anchorage from a palatal implant to correct an infraoccluded maxillary first molar in a young adult.

Tooth ankylosis during adolescence and early adulthood can lead to infraocclusion and several interrelated, adverse sequelae at the intra-arch and interarch levels. An orthosurgical treatment modality that includes surgical luxation and immediate orthodontic traction is recommended as a conservative approach in many patients. The key to success in this approach is the timely delivery of relatively heavy and continuous forces to the luxated tooth to prevent its reankylosis. Because high reactive forces are inevitably generated, it is crucial to create a reliable source of anchorage. This report describes the successful use of an osseointegrated orthodontic implant to reinforce the anchorage during the orthosurgical repositioning of an infraoccluded molar in a young adult.

Orthodontic treatment of a transmigrated mandibular canine: a case report.

BACKGROUND: Intraosseous migration of a lower canine across the midline is a rare dental anomaly. The treatment options include: forced eruption of the unerupted tooth using orthodontic traction, autotransplantation, extraction followed by prosthetic replacement. AIM: To report the management of a transmigrated lower right canine. METHOD: The treatment involved surgical, orthodontic and cosmetic dental treatment. No permanent teeth were extracted. RESULTS: The transmigrated canine was placed between the left central and lateral incisors and the crown recontoured to simulate a lateral incisor. An acceptable aesthetic and functional outcome was gained. CONCLUSION: Transmigration is a rare dental condition that can be treated successfully with a collaborative effort from several dental disciplines.

Orthodontic tooth extrusion to enhance soft tissue implant esthetics.

PURPOSE: The purpose of this report was to review the published data on orthodontic extrusion and make recommendations for its use according to the evidence presented, including the technique for use by clinicians. MATERIALS AND METHODS: A MEDLINE search was performed to identify reports in referenced journals in English. These studies were collated and reviewed for clinical and animal data on orthodontic extrusion. In addition, the experiences of our team using orthodontic extrusion was added to the evidence used to make the recommendations. RESULTS: From this background information, orthodontic tooth extrusion is able to move the soft tissues when the sulcular attachment apparatus is intact. Bone formation as the tooth is extruded is dependent on the vector of the movement of the tooth. The rate of tooth extrusion is effected by the bone-tooth attachment. CONCLUSIONS: When used as we have described, extrusion can effectively move the facial gingival margin to allow for esthetic restoration of implants placed in the extruded tooth position.

Atraumatic teeth extraction in bisphosphonate-treated patients.

PURPOSE: The purpose of this study was to suggest an alternative technique for atraumatic teeth extraction that would prevent bone exposure and the associated complication of osteonecrosis of the jaws in bisphosphonate (BP)-treated patients, without terminating the treatment. PATIENTS AND METHODS: A total of 10 patients treated with BPs for multiple myeloma, metastatic breast cancer, and osteoporosis, requiring dental extractions of nontreatable teeth, were included in this study. The extractions were performed by means of orthodontic elastics placed around the roots, causing slow and gradual exfoliation of the teeth. RESULTS: The technique was applied to 21 roots of 15 teeth. A total of 19 roots exfoliated spontaneously. Two roots had to be removed with minimal manipulation by forceps. The mean time required for exfoliation was 5.8 weeks. All sockets showed soft tissue secondary healing and there were no signs of inflammation or exposed bone during the 9-month follow-up. CONCLUSIONS: Atraumatic extraction by use of elastics is a safe technique that may be used in BP-treated patients to prevent osteonecrosis of the jaws.

Erbium laser treatment of an impacted first mandibular premolar: a case report.

Dental impaction defines a tooth that, instead of erupting to occupy its functional position, is partially or totally retained and remains within the bone. Retained teeth can be placed in the normal arch position through a combination of orthodontics and conventional surgical techniques, or a combination of orthodontics and laser surgery, as in the case here presented of a 14-year-old boy with an impacted first mandibular premolar, covered by bone, and with complete root formation and an erupted second premolar. The impacted premolar was surgically exposed using an Er,Cr:YSGG laser and at the same time an orthodontic bracket was bonded to provide traction to move the first premolar into its arch position.

[Orthodontics in general practice 4. Impaction of maxillary front teeth]. / Orthodontie in de algemene tandartspraktijk 4. Eruptieproblemen in het bovenfront.

Eruption failures in the maxillary frontal region occur during the mixed dentition period. Dislocation and impaction of central incisors are diagnosed during or at the end of the early mixed dentition stage. These failures can be caused by crowding, premature loss of deciduous teeth, trauma or supernumerary teeth. Occasionally, a preventive orthodontic treatment is desirable to release the obstructed eruption path of a canine. Sometimes, a surgical intervention may be indicated to expose an obstructed central incisor and to remove supernumerary teeth. Retention and impaction of canines are generally discovered late in or after the late mixed dentition stage. In the agenesis of the lateral incisors or peg-shaped teeth, there is frequently impaction of the canines. General dental practitioners must be alert for possible deviations in the pattern of change in dentition right from the early mixed dentition period. Conventional two-dimensional radiographs can sometimes unjustifiably suggest a bad prognosis of an impacted tooth. Cone-beam CT scanning, which gives a three-dimensional image, can provide important additional diagnostic information.

Orthodontic-periodontal interactions: Orthodontic extrusion in interdisciplinary regenerative treatments.

Orthodontics is a periodontal treatment. "Guided orthodontic regeneration" (GOR) procedures use orthodontic movements in perio-restorative patients. The GOR technique includes a guided orthodontic "soft tissue" regeneration (GOTR) and a guided orthodontic "bone" regeneration (GOBR) with a plastic soft tissue approach and a regenerating reality. The increased amount of soft tissue gained with orthodontic movement can be used for subsequent periodontal regenerative techniques. The increased amount of bone can as well improve primary implant stability and, eventually, simplify a GTR technique to regenerate soft tissues, to restore tooth with external resorption in aesthetic zone or to extract a tooth to create new hard-soft tissue for adjacent teeth.

[Reason for failure in the treatment of impacted and retained teeth]. / Échec de la mise en place de dents retenues et incluses.

The positioning of an impacted or retained tooth in either children or adults presents a real challenge for the two practitioners involved, the orthodontist and the surgeon in charge of the surgical exposure. The maxillary canine is the tooth most often impacted in the anterior segment, with a prevalence of 2% in the general population. One can understand, therefore, the functional and esthetic challenge for the surgical-orthodontic team whose aim will be to reposition the impacted or retained tooth in the arch. A large number of mistakes must be avoided in order to achieve a satisfactory result for both the patient and the practitioner. Modern imaging techniques should be used to obtain a precise diagnosis of the location of the tooth and to perform surgery which will spare the tooth in question as well as the surrounding anatomic structures. The directions and forces of the traction used will need to be carefully thought out in order to move the tooth into its final position on the arch in optimal conditions. The periodontal setting will be optimized and checked at every step of the treatment. The aim, in fact, is to anticipate the onset of periodontal problems on the grounds that prevention is easier than cure.

Orthodontic extrusion: periodontal considerations and applications.

Human teeth erupt naturally to compensate for tooth wear and tear. When a subgingival lesion such as crown fracture occurs, the general practitioner must consider orthodontic extrusion of the tooth to allow for prosthetic rehabilitation. However, because this therapeutic approach is not appropriate in all cases, each tooth must be carefully analyzed before treatment. The amount of force applied depends on the desired effect. Orthodontic extrusion can also be used to augment bone and tissue in the course of preparing an implant site. In most cases, endodontic treatment must be completed first, with close attention being paid to the contour of the final restoration. The benefits of extrusion are clear, but patients must nonetheless be informed of the disadvantages.

Reabilitação dentária anterior através da extrusão ortodôntica lenta e instalação de implante com provisionalização imediata ­ relato de caso / Anterior dental rehabilitation through slow orthodontic extrusion and implant installation with immediate prosthesis ­ case report

A remoção de um elemento dentário resulta em reabsorção óssea alveolar como consequência do processo natural de reparação, sobretudo, em região anterior. Essa reabsorção pode limitar ou até comprometer a reabilitação estética e funcional do dente perdido. Diante da previsibilidade das mudanças ocorridas no pós-extração, tem-se considerado cada vez mais a modalidade de reabilitação no mesmo instante da remoção do dente comprometido. Em casos específicos de recessão gengival e perda óssea vestibular, na presença de raiz remanescente, a Ortodontia exerce papel fundamental na adequação dos tecidos da região acometida, pois possibilita alterar a posição do osso alveolar e margem gengival, aumentando o potencial estético do caso. O objetivo desse trabalho foi demonstrar as etapas clínicas de um caso de extrusão ortodôntica lenta com o objetivo de neoformação óssea na região apical e reposicionamento coronal dos tecidos ósseo e gengival para instalação de implante imediatamente após a extração, seguido da colocação de coroa provisória imediata (AU).

Removal of a dental element results in alveolar bone resorption as a consequence of the natural repair process, especially in anterior region. This resorption may limit or even compromise the aesthetic and functional rehabilitation of the lost tooth. In view of the predictability of changes in post-extraction, the rehabilitation modality has been increasingly considered at the same time as the removal of the involved tooth. In specific cases of gingival recession and vestibular bone loss, in the presence of remaining root, orthodontics plays a fundamental role in the adequacy of the tissues of the affected region, since it allows altering the position of the alveolar bone and gingival margin, increasing the aesthetic potential of the case. The objective of this study was to demonstrate the clinical stages of a slow orthodontic extrusion with the objective of bone neoformation in the apical region and coronal repositioning of the bone and gingival tissues to implant the implant immediately after the extraction, followed by the placement of an immediate provisional crown (AU).