Orthodontic Cataclysm: A Rare Case Report

Abstract

A ligature wire tie was proposed as being the source of pain, discomfort that progressed to huge swelling in a healthy adolescent patient during the course of orthodontic treatment. On clinical examination, the patient had actual swelling associated with extraoral swelling. Radiographic examination of an IOPA revealed a cut piece of ligature tie lingual to the retromolar area. The patient was referred to the department of oral and maxillofacial surgery for retrieval and appropriate treatment. On table, it was found that the ligature tie was displaced and found lingual to the retromolar area.

Full text

The Journal of Indian Orthodontic Society, October-December 2014;48(4):00-00
1
JIOS
Orthodontic Cataclysm: A Rare Case Report
Orthodontic Cataclysm: A Rare Case Report
1Sumita Mishra, 2Kanhu Charan Sahoo, 3Smruti Bhusan Nanda
ABSTRACT
A ligature wire tie was proposed as being the source of pain,
discomfort that progressed to huge swelling in a healthy
adolescent patient during the course of orthodontic treatment.
On clinical examination, the patient had actual swelling
associated with extraoral swelling. Radiographic examination
of an IOPA revealed a cut piece of ligature tie lingual to the
retromolar area. The patient was referred to the department
of oral and maxillofacial surgery for retrieval and appropriate
treatment. On table, it was found that the ligature tie was
displaced and found lingual to the retromolar area.
Keywords: Orthodontic, Iatrogenic, Cataclysm, Ligature wire.
How to cite this article: Mishra S, Sahoo KC, Nanda SB.
Orthodontic Cataclysm: A Rare Case Report. J Ind Orthod Soc
2014;48(2):00-00.
Source of support: Nil
Conict of interest: None
Received on: 12/09/13
Accepted after Revision: 19/12/13
INTRODUCTION
There have been reports of various adverse effects of ortho-
dontic treatment.1 A foreign body etiology could attribute
to local iatrogenic factors that promote inf lam matory
changes.2 Plaque accumulation is the result of fixed or
removable orthodontic appliances that hamper oral hygiene
maintenance.3
There are very rare instances where a ligature tie has
penetrated into the mucosa and led to swelling and injury
to patient’s health. A few studies evaluated the methods of
commercially available elastomeric ligations as an addi tional
factor.4,5 This report describes a case of mucosal ulceration,
extraoral swelling caused by a displaced ligature wire tie.
CASE REPORT
A 13-year-old patient undergoing orthodontic treatment
reported with the chief complaint of dull pain in relation to
lower left rst permanent molar.
CASE REPORT
1,2Senior Lecturer, 3Reader
1,2,3Department of Orthodontics, Institute of Dental Sciences,
Bhubaneswar, Odisha, India
Corresponding Author: Sumita Mishra, Senior Lecturer,
Department of Orthodontics, Institute of Dental Sciences,
Bhubaneswar, Odisha, India, Phone: 2386336, e-mail: sumita.
mitali@gmail.com
10.5005/jp-journals-10009-00
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The patient had no relevant medical history and was free
of systemic symptoms. On clinical examination, the patient
had intraoral swelling with punctuation and ulceration distal
to the lower left second molar (Fig. 1). IOPA was taken in
the concerned region. On examination of IOPA, a thin wire
was observed in the retromolar area (Fig. 2). The patient
was referred to department of oral and maxillofacial surgery
for opinion and treatment. On surgical intervention, the
foreign object was removed and detected as a cut ligature
wire tie (Figs 3 and 4). All active orthodontic forces were
temporarily removed and the patient was under constant
monitoring and follow-up.
Fig. 2: IOPA showing a cut ligature wire tie
Fig. 1: Intraoral left lateral view showing punctation
in relation to retromolar area

Sumita Mishra et al
2
DISCUSSION
Fixed or removable orthodontic appliances also impede
the maintenance of oral hygiene, resulting in plaque accu-
mulation.6,7 The present report emphasizes the need for
careful handling of ligature wires during orthodontic treat-
ment.
It also highlights potential risks to the periodontium
caused by using orthodontic ligature wire ties. Localized
reac tive overgrowth of the gingiva can include the diffe-
rential diagnosis of peripheral granuloma, peripheral giant
cell granuloma and abscess.8-10
It can result from invasion of pyogenic bacteria through
pocket epithelium secondary to microtrauma. The onset is
sudden and is followed by acute inammatory response
(purulence). Careful observation of the affected area intra-
orally gave the impression of a foreign body etiology but it
was one of a rare instances where inadvertent force while
removing the laceback tie led to such an injury.
CONCLUSION
It was concluded that although tying ligatures is a simple
procedure, every possible precaution should be taken to
ensure that such an incident is avoided.
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Fig. 3: Surgical intervention Fig. 4: Retrieved ligature wire tie displaced
into the retromolar space