Content uploaded by Mehmet Bayram
Author content
All content in this area was uploaded by Mehmet Bayram
Content may be subject to copyright.
A preview of the PDF is not available
Bilaterally Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treatment: A Case Report
Abstract and Figures
Maxillary central incisor impactions occur infrequently. Their origins include various local causes, such as odontoma, supernumerary teeth, and space loss. Supernumerary and ectopically impacted teeth are asymptomatic and found during routine clinical or radiological examinations. The surgical exposure and orthodontic traction of bilaterally impacted central incisors after removal of impacted supernumerary teeth is presented in this report.
Citation
Bayram M, Özer M, SŞener I. Bilaterally Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treatment: A Case Report. J Contemp Dent Pract 2006 September;(7)4:098-105.
Figures - uploaded by Mehmet Bayram
Author content
All figure content in this area was uploaded by Mehmet Bayram
Content may be subject to copyright.
... Impaction of the permanent teeth is not commonly seen during the mixed dentition period, especially impaction of maxillary incisors. Among the incisors, the most prevalent impaction is seen in maxillary central incisors [1,2]. There are various etiologic factors related to impaction of central incisors, such as supernumerary teeth, odontoma, and trauma. ...
... Disturbance in the eruption of anterior teeth will cause serious esthetic problems. Thus, treatment of maxillary incisor impaction is imperative [2]. Considering the possibility of alveolar bone resorption, it is preferred to preserve the impacted teeth instead of their extraction, as much as possible. ...
... Considering the possibility of alveolar bone resorption, it is preferred to preserve the impacted teeth instead of their extraction, as much as possible. Different factors such as position and inclination of impacted teeth, degree of dilaceration, and possibility of providing space for the impacted teeth are effective on the success of orthodonticsurgical treatment of impacted teeth [2]. The use of laser has been suggested in orthodontics and pediatric dentistry, and it has been applied for different treatments such as surgical exposure of impacted teeth [4,5]. ...
Impaction of the anterior teeth, which is less frequent in central incisors, can cause serious esthetic and subsequent psychological problems for patients during the mixed dentition period. Traumatic injury to deciduous teeth is the most common etiologic factor. Thus, treatment of maxillary incisor impaction is highly important. Nowadays, application of laser has been suggested in orthodontics and pediatric dentistry for different treatments, such as surgical exposure of impacted teeth and application of low-level laser therapy (LLLT) for acceleration of orthodontic tooth movement. In this paper, the authors present treatment of an impacted and dilacerated maxillary central incisor with laser application for its surgical exposure and LLLT for acceleration of its orthodontic traction and eruption.
... There are two guided eruption techniques towards the center of the alveolar ridge: closed [34] and open [35,36]. In the first technique, an orthodontic bracket is attached to the tooth surface after a full-thickness flap is lifted, and the tooth and bracket are then entirely covered with tissue; meanwhile, the latter (open) method consists of apical repositioning of the full-thickness flap, leaving the element open [36][37][38]. The closed guided eruption technique was adopted in the clinical case described [20]. ...
Background: In the literature, there are few studies on included mandibular canines and possible therapeutic solutions for arch restoration. The aim of this review was to evaluate how the recovery of included mandibular canines is performed in adolescent patients with mixed or permanent dentition. The clinical case reported is that of successful orthodontic surgical treatment in an 11-year-old mixed-dentition patient with an included mandibular right canine. Methods: A literature search was performed using the PubMed/Medline, Scopus, Web of Science, and Cochrane Library databases with the following Boolean indicators: canine, mandibular, impacted. The inclusion criteria were year of publication between 2017 and 2022, orthodontic canine surgical approach included, age between 9 and 18 years, free full text, and English language. Results: A total of 536 articles was identified through the electronic search, and 11 articles published between 2017 and 2022 were ultimately included in the qualitative analysis. Conclusions: In the majority of cases, combined surgical–orthodontic therapy, as reported in the studies that we reviewed, is successful in correcting the eruption defect, restoring the canine to occlusion and the physiological arch perimeter, and maintaining the health of the periodontal supporting tissues.
... Clinically, eruption disturbances can be diagnosed when a six-month tooth eruption delay or more is observed compared to its homologue. 4,5 Eruptive delays occur due to obstructive or traumatic cause. [6][7][8][9] Obstructive factors involve any kind of physical barrier to the eruption, such as supernumerary teeth, tooth-bone discrepancies, gingival fibrosis, ankylosis, retained primary teeth, early loss of deciduous teeth, presence of cysts, odontomas or tumors in the region, among others. ...
Background:
The aim of this study was to evaluate the clinical and radiographic periodontal status of impacted permanent maxillary central incisors (Mx.1) after a long term of orthodontic traction.
Methodology:
This split-mouth study evaluated a sample of 11 patients (five females, six males) treated with Mx.1 unilateral traction one to 28 years after the removal of orthodontic appliances. The traction Group (TG) consisted of 11 Mx.1 and the Comparison Group (CG) comprised 11 spontaneously erupted contralateral Mx.1. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross-section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa, and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t-, McNemar's, and Wilcoxon tests (p<0.05).
Results:
Compared to CG, we found a significantly thinner labial bone plate thickness in TG at the middle (p=0.000) and apical (p=0.009) root level. We also observed an apical displaced labial bone crest level in TG (p=0.000). The Traction Group showed a greater frequency of root dilacerations and gingival recessions, a decreased amount of keratinized mucosa, and a decreased clinical attachment level at the labial aspect compared to contralateral teeth.
Conclusions:
A decreased thickness and height of labial alveolar bone and gingival recessions were found in maxillary central incisors 15 years after orthodontic traction. Though incisor traction might cause some periodontal impact, differences are acceptable under a clinical point of view considering the cost-benefit ratio.
... It involves lifting a full-thickness flap, fixing an orthodontic bracket on the tooth surface, and then completely covering the tooth and bracket with tissue. These techniques offer some advantages when pulling impacted teeth [10,31,32]. ...
The inclusion of both maxillary permanent central incisors is uncommon. This condition
compromises face aesthetics, phonation andmasticatory function. Therefore, early diagnosis is essential to avoid complications and failures. There are various reasons for inclusion, but supernumerary teeth are the leading cause. Early causes of removal and rapid expansion of the palate determine a high probability of success with the spontaneous eruption of the impacted elements. However, it is often necessary to proceed with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. In this case report, the orthopantomogram (OPG) X-ray of a 9-year-old boy revealed two impacted supernumerary teeth in the anterior maxillary region, preventing the eruption of the permanent upper central incisors. The impacted supernumerary teeth were surgically removed at different times. A straight wire multibrackets technique associated with a fixed palatal appliance was used. The palatal appliance featured an osteomucous resin support at the level of the retroincisal papilla. Subsequently, surgical exposure was carried out using the closed eruption technique and elastic traction, bringing 11 and 21 back into the arch.
... Once complete, the symbiosis of several medical specialties may be necessary. In response to the situation, several treatment options are available [12,14,15]. ...
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent central incisor has multiple etiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally, the earlier treatment is provided, the higher the likelihood of success and the less the complexity. Our results suggest that close monitoring and interdisciplinary cooperation during the treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.
This paper presents a case with a deeply impacted maxillary left incisor that was managed by combined orthodontic - surgical technique.
... This is influenced by several factors, including: the position and direction of the impacted tooth, the degree of tooth root formation, the presence/absence of macerated teeth and the availability of space for tooth eruption. 5, 6 The purpose of this case report is to observe the process of fixed orthodontic treatment in cases of central incisor by orthodontic treatment and process of fixed orthodontic treatment in cases of central incisor by orthodontic treatment and surgical procedures with closed method exposure. ...
Objective: This article discusses case reports of impacted maxillary central incisor with orthodontic treatment approaches and minor surgical exposure measures. Methods: A 12-year-old male patient presents with impacted maxillary central incisor, complaining of the appearance and aesthetics of his face. Objective examination showed edentulous in region 21 and the area narrowed. and the area narrowed. Results: An orthodontic treatment is performed to open the space, followed by surgical exposure to attach a button for impacted tooth withdrawal. Conclusion: Maximum results are obtained with interdisciplinary treatment, in this case minor surgical exposure by an oral surgeon. Abstract Introduction
... Herhangi bir sendromla ilişkisi olmayan, çok sayıda süpernümerer diş gözlenen olgu sayısı oldukça azdır (Orhan, Özer & Orhan, 2006). En sık olarak görülen süpernümere diş, maksiller santraller arasında yer alan meziodens'dir (Bayram, Ozer & Sener, 2006). Bu olguda 2 üst santral diş arasında meziodens varlığı tespit edilen hastanın teşhisi, tedavisi ve takibi sunulmuştur. ...
Artı dişler, normal dentisyona ilave olarak fazladan sürmüş veya gömülü kalmış diş ya da diş benzeri yapılardır. Artı dişlerin etşyolojisi tam olarak bilinmemektedir. Artı dişler her iki cinsiyette de farklı yaş gruplarında görülebilmektedir. 8 yaşındaki erkek çocuk hasta dişlerinde şekil ve görüntü bozukluğu şikayeti ile kliniğine başvurdu. Yapılan ağız içi ve radyografik değerlendirmeler sonucu üst daimi keser dişler arasında fazla diş varlığı tespit edildi. Hastanın görüntüsünden memnun olmamasının yanında fazla diş varlığı dental ve ortodontik problemler yaratacağı nedeniyle dişin çekimine karar verildi. Diş çekimi yapıldıktan sonra belirli aralıkla takip edildi ve dişlerin arasındaki boşluğun kapanmaya başladığı tespit edildi. Hastanın diğer dental işlemleri de bu süre içinde tamamlandı. Hasta rutin aralıklarla takip edilmektedir
BACKGROUND
Dilaceration is a rare dental developmental anomaly characterized by an abrupt deviation along the longitudinal axis of the root in which an angulation forms between the root and the crown. Here, we report on dilacerated bilateral maxillary central incisors in mixed dentition.
CASE SUMMARY
A 10-year-old girl presented with a chief complaint of unerupted central incisors. An oral examination and radiography provided the basis for a diagnosis of dilaceration of the maxillary central incisors. After surgical exposure of the impacted teeth, a button with an attached chain was applied to the palatal surface of teeth 11 and 21. After 8 mo, a button was bonded to the labial surface of the crown to fix an elastic chain and move the teeth toward the maxillary arch. Finally, a fixed appliance was applied to tooth alignment to Class 1 malocclusion using a 0.019 × 0.025-inch nickel-titanium wire. After 3 years of follow-up, the clinical findings and radiographic assessment showed that the roots had developed with vital dental pulp and healthy periodontium, were acceptable aesthetically, and showed no resorption.
CONCLUSION
The rare occurrences of dilacerated bilateral maxillary central incisors can be successfully treated through surgical exposure and orthodontics.
Se presenta el caso de un paciente de sexo femenino, de 8 años 9 meses de edad, que acude al Centro Odontológico de la Universidad Científica del Sur por ausencia de un incisivo central, madre refiere como antecedente trauma en la dentición decidua. Fue evaluada clínicamente y se le solicitaron radiografías panorámica y cefalométrica, las cuales evidenciaron la presencia de un mesiodens el cual ocasionaba la impactación del incisivo central superior. Dadas las condiciones de la pieza se optó por un tratamiento quirúrgico en dos pasos acompañado de tracción ortodóntica progresiva, seguido de la técnica 4x2.
There may be instances in which this technique is applicable in an adult, assuming the risk of pulpal devitalization. After the tooth is firmly established, root canal therapy can be done. In such cases a well-positioned natural tooth, though deliberately devitalized, is preferable to an artificial replacement.The subject of this symposium is most interesting and the pooling of ideas and techniques should lead to refinements which will make our present concepts primitive within a few years.
An overview of the incidence and sequelae, as well as the surgical, periodontal, and orthodontic considerations in the management, of impacted canines is presented. The clinician needs to be familiar with the differences in the surgical management of the labially and palatally impacted canines, the best method of attachment to the canine for orthodontic force application, the advantages of one-arch versus two-arch treatment, and the implications of canine extraction. The various factors that influence all these decisions are discussed.
Usually supernumerary teeth in the maxilla are removed surgically, often due to retention of the permanent teeth in the region, but in certain cases the supernumerary teeth do not cause alterations in the eruption, position or integrity of the permanent dentition. This study was performed in order to review the indications for such surgical removal. The patient records of 208 patients with supernumerary teeth during the period of 1970-81 were reviewed retrospectively. Of these patients, 52 non-operated were furthermore examined clinically and radiographically in 1982; mean observation time 7.3 years (1-22 years). Results showed that none of the 52 non-operated patients had any symptoms or pathologic conditions related to the supernumerary teeth. In 37%, progressive resorption of the supernumerary teeth was seen, and in 24% the pericoronary space was markedly reduced compared to the first examination. The position and morphology was found to have influence on the prevalence of retention of the permanent incisors (p less than 0.0001). Widening of the pericoronary space during the observation period of the non-operated patients was not seen in any of the cases. Of the total of 262 teeth, 2 well-defined pericoronary cyst (pericoronary space greater than or equal to 5 mm) were found. From the present study, it is concluded that supernumerary teeth in the premaxilla may cause pathological conditions. However, each case must be considered individually concerning surgical treatment, and if no retention of permanent teeth or pathological conditions are present, observation with regularly radiographic controls is advisable. Enlarged pericoronary space (1-3 mm) does not alone seem to indicate surgical treatment.
The impacted or mal-erupted tooth and its associated pathosis provide great diagnostic challenges to the dentist. The frequency of occurrence of impaction was found to be over 10,000 in 5,000 Army recruits. The type and position of impaction are summarized in tables. The incidence of impactions was higher than previously reported and may reflect some sampling bias. The incidence of impacted second and fourth molars is higher than expected. Impactions or mal-eruptions were seen to involve every permanent tooth except the mandibular incisors and first molars. Impactions can occur because of malpositioning of the tooth bud or obstruction in the path of eruption. However, the exact mechanism is still unknown. Six unusual cases of impacted permanent teeth are described to illustrate the importance of panoramic radiographs in the discovery of some anomalously located impactions.
The impacted maxillary central incisor in a child poses a disturbing esthetic dilemma to parents, by virtue of its location. Neither the orthodontist nor the parents prefer to wait for the fully erupted permanent dentition and comprehensive orthodontics to resolve this problem. This challenge can be met in the early mixed dentition stage, as described with these two cases. The response to the technique was excellent. The patients now possess confidence to smile and have enhanced self-esteem, which is critical even in early life. Just as important is that the newly positioned maxillary central incisor is the natural tooth, not a temporary prosthesis that can loosen or break. Gingival contour is a consideration, however.
Impacted Incisor With Dilaceration refers to a dental deformity characterized by an angulation between crown and root causing noneruption of the incisor. Surgical extraction used to be the first choice in treating the severely dilacerated incisor. In this article, a horizontally impacted and dilacerated maxillary central incisor was diagnosed radiographically. By combining two stages of the crown exposure surgery with light force orthodontic traction, the impacted dilacerated incisor was successfully moved into proper position. However, long-term monitoring of the stability and periodontal health is critical after orthodontic traction.