Orthodontic movement of a dilacerated maxillary incisor in mixed dentition treatment

Abstract –  Dilaceration is a dental deformity characterized by an angulation between crown and root causing non-eruption of the tooth. It generally occurs following trauma to the deciduous dentition the apices of which lie close to the permanent tooth buds. Surgical extraction used to be the first choice in treating the severely dilacerated teeth. In this case report, it is described how a dilacerated central incisor was successfully moved into alignment in a young patient with proper surgical and orthodontic management avoiding use of prosthetic/implant devices. The panoramic radiograph after the traumatic injury is compared with the one at the end of treatment. The results were sustainable over long-term in both periodontal and aesthetic terms.     

Treatment of an impacted dilacerated maxillary central incisor.

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.     

Orthodontic treatment of an impacted dilacerated maxillary incisor: a case report

Dilaceration is one of the causes of permanent maxillary incisor eruption failure. It is a developmental distortion of the form of a tooth that commonly occurs in permanent incisors as result of trauma to the primary predecessors whose apices lie close to the permanent tooth germ. We present a case of post-traumatic impaction of a dilacerated central maxillary left incisor in a young patient with a class II malocclusion.     

Interdisciplinary management of impacted maxillary central incisor with dilacerated crown

Introduction

Dilaceration of the permanent teeth usually occurs because of trauma to their deciduous predecessors. Dilaceration in the crown is rare compared with that in the root and is more common in the maxillary and mandibular incisors. Generally, surgical exposure of the tooth followed by orthodontic traction or extraction of the tooth is the the choice of treatment.

Methods

This article highlights a surgical-endodontic approach to the management of the left permanent maxillary central incisor with dilaceration of the crown.

Results

The 1-year follow-up showed good stability of the prosthesis and good periodontal health.

Conclusions

Surgical resection of the crown followed by endodontic treatment and restoration is a viable and rapid option for the management of crown dilaceration.     

Orthodontic-surgical management of an impacted dilacerated maxillary central incisor: a clinical case report

Dilaceration is one of the causes of maxillary central incisor eruption failure. Surgical excision is frequently the first choice of treatment for a severely dilacerated incisor. In this article, the case of a horizontally impacted and dilacerated maxillary central incisor was diagnosed and treated by surgical exposure using the apically repositioned flap technique combined with orthodontic traction. The dilacerated incisor was successfully moved into alignment, with pulpal vitality and periodontal health present 2 years following treatment.     

Orthodontic treatment of an impacted dilacerated maxillary central incisor combined with surgical exposure and apicoectomy

The impacted incisor was moved into its proper position with surgical exposure and orthodontic traction. Although apicoectomy was performed during the orthodontic treatment, the incisor showed good stability after the long retention period.     

Surgical extrusion of a partially erupted and crown dilacerated incisor

Abstract –  A case report of treatment for an incompletely erupted maxillary central incisor with crown dilaceration in a 12-year-old boy is described. The tooth was repositioned with surgical extrusion and endodontically treated through use of calcium hydroxide paste. Clinical and radiographic examination 2 years after completion of combined surgical and endodontic treatment revealed periapical healing and no signs of root resorption.     

Surgical repositioning of impacted mandibular second molar teeth

Impacted second molars refractory to orthodontic treatment are frequent problems. The family dentist and the orthodontist should be on the alert for them. A philosophy for their management and the authors' experience over the past 13 years are presented. The proper time for definitive treatment of these impactions is during early adolescence, generally in the 11- to 14-year range. Impaction of the second molar is usually a problem of arch length deficiency. There may be an associated problem with a third molar impaction. The alternatives for impacted second molar treatments are surgical repositioning with or without adjacent third molar removal, removal of the second molar allowing the third molar to erupt, and transplantation of the third molar to the second molar socket. In the authors' experience, surgical repositioning has provided the most promising results of the three choices. Technical aspects of surgical repositioning are discussed along with case selection criteria. Six cases are presented to demonstrate typical problems and their management. With proper timing and intervention, the prognosis is excellent for repositioning second molar impactions.     

Treatment of an "ankylosed" upper central incisor in the mixed dentition

A ten-year-old boy presented with an unerupted upper right central incisor (UR1). An OPG radiograph showed a supernumerary tooth lying over its crown, preventing its eruption. Standard orthodontic treatment involving removal of the supernumerary tooth, attaching a gold chain to the UR1 and treatment with fixed orthodontic appliances failed to bring the tooth down, until it was found that tough fibrous gingival tissue entwined in the gold chain had "ankylosed" the tooth. Once this tissue had been removed and the wound packed open, the tooth was brought down successfully into occlusion.     

Surgical and orthodontic treatment of an impacted permanent incisor: case report

Abstract –  This case report presented a combined surgical/orthodontic treatment of an impacted permanent incisor of a 10-year-old boy. Trauma to the primary dentition caused the impaction of the maxillary left permanent central incisor. Application of push coil spring between the adjacent teeth created space for the impacted tooth. A button with an extension of ligature wire was bonded to the maxillary left permanent central incisor to bring it into the arch. The maxillary left permanent central incisor was brought to its proper position after 16 months of active orthodontic treatment.     

Severe crowding and a dilacerated maxillary central incisor in an adolescent

This study reports the treatment of an adolescent patient with dilacerated maxillary incisor. She complained of severe crowding with a high-positioned left upper canine. Her left central incisor had been impacted and moved to proper position at the age of eight years, resulting in a severe root dilaceration. To avoid any progression of root dilacerations and resorption in the maxillary incisor, maxillary lateral expansion and molar distalization plus multibracket appliance were selected as the best nonextraction treatment plan. The maxillary expansion and molar distalization should provide adequate space for the correction of the severe crowding, and treatment with a multibracket appliance was initiated. After a 17-month treatment with a multibracket appliance, an acceptable occlusion was achieved with a Class I molar relationship. An acceptable occlusion was maintained without recurrence of the crowding and impairment of the dilacerated root in the maxillary incisor during three years of retention. It is emphasized that careful planning is required to avoid any progression of the root dilaceration and resorption through orthodontic treatment. A shortening of the period of applying orthodontic force on the dilacerated incisor and avoidance of tooth extraction will minimize the risk factors.     

Conservative management of an impacted incisor

There are several techniques available to the practitioner for the treatment of impacted, fully developed teeth. These techniques often involve surgical and/or orthodontic manipulation of the affected tooth. A more conservative approach was used in the case presented here, involving a boy who was 12 years 5 months old. An odontoma was surgically removed and the impacted tooth was allowed to erupt without the aid of external forces.     

Orthodontic surgical treatment on an upper central dilacerated incisor in an adult patient

This study describes how a dilacerated upper central incisor was repositioned in the dental arch in an adult patient with proper surgical and orthodontic management avoiding use of prosthetic implants. The results were sustainable long term in both periodontal and aesthetic terms.