Management of a Class I malocclusion with traumatically avulsed maxillary central and lateral incisors

This case report describes orthodontic space closure for managing an avulsed maxillary central incisor and a lateral incisor in a growing girl with a Class I deep bite malocclusion with moderate lower and mild upper crowding. The treatment approach moved a central incisor across the midline and substituted a lateral incisor for a central incisor, in combination with canine substitution. Veneers on all maxillary anterior teeth attained acceptable esthetics. The right central incisor was moved to serve as the avulsed left central incisor. The right lateral incisor was moved to the position of the right central incisor and restored. The canines on both sides were substituted as lateral incisors; the posterior occlusion was left in Class II. Mesialization of central and lateral incisors with prosthetic rehabilitation is an acceptable treatment option.     

Treatment of a transmigrated and an impacted mandibular canine along with missing maxillary central incisor: A case report

IntroductionTreatment of a case with impacted canines is complex and numerous options are available ranging from disimpaction to forced eruption.ObjectiveThe objective of this case report was to describe the treatment of a 19-year-old male, with a skeletal Class II, dental Class II Division 1 malocclusion, prognathic maxilla, proclined maxillary incisors, with missing left maxillary central incisor and bilateral mandibular canine impaction.MethodologyThe orthodontic treatment plan included forced eruption of the impacted canines and conversion of maxillary left lateral incisor to central incisor.ConclusionProper diagnosis and implementation of orthodontic biomechanics can minimize the amount of prosthetic and surgical intervention needed in the management of transmigrated canine and smile designing.     

Detailed three-dimensional orthodontic tooth repositioning to improve restorative outcome:: A case report

The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.     

Bone augmentation and autogenous transplantation of premolar to the site of the fissure in a cleft palate patient

This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non‐syndromic 10‐year‐old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients.     

正畸治疗中阻生牙助萌术1例

目的 以正畸治疗中阻生牙助萌术为例,探讨正畸患者的牙周手术设计中应注意的问题。诊治过程：25岁男性患者,牙龈呈炎症表现,牙列不齐,右上颌侧切牙阻生。前牙深覆牙合,双侧第一磨牙及尖牙远中关系,右上颌中切牙和尖牙间存在间隙。前期通过正畸治疗排齐牙列,并开辟右上颌侧切牙处的间隙。在完成牙周基础治疗的前提下,设计偏腭侧切口,在有效暴露阻生牙的前提下尽可能保存所有软组织,同时根据正畸牙移动的目标位置行骨增量和软组织增量,术后牵引并排齐右上颌侧切牙。结果 通过合理的牙周手术设计,本病例在正畸过程中保持了牙周软硬组织的健康。结论 正畸患者的牙周手术设计应同时关注正畸需求和牙周健康。     

Lateral root dilaceration: a multi-disciplinary approach to treatment

Abstract This Case report illustrates the importance of coordinating various dental specialties in the successful treatment of the traumatized patient. The patient sustained multiple traumatic injuries to the anterior maxilla in the primary and permanent dentition stages of development. Orthodontic considerations involved in this case included an unerupted maxillary right central incisor with dilaceration of its root, severe malocclusion, and compromised esthetics. Endodontic concerns were directed toward the traumatized primary and permanent maxillary incisors with subsequent devitalization of the maxillary right permanent central incisor and calcification of the maxillary left permanent incisor. Oral surgery, oral pathology and general dentistry were also involved throughout the course of treatment.     

Recovery of multiple impacted maxillary teeth in a hyperdivergent Class I patient using Temporary Skeletal Anchorage Devices and augmented corticotomy

Treatment of multiple impacted teeth is challenging. Three-dimensional treatment planning can help in delivering a better outcome. This case report presents a patient with an incomplete dental transposition between the canine and lateral incisor of the maxillary right side associated with the impaction of a dilacerated right central incisor. Using a two-stage surgical exposure and augmented corticotomy, the patient''s occlusion and smile esthetics were significantly improved, and Class I occlusal relationships with optimal overjet and overbite were achieved after 50 months of orthodontic treatment. Thirty-month posttreatment records revealed a stable result.     

Orthodontic treatment of fused and geminated central incisors: a case report

A 10-year old Egyptian male presented with a geminated upper right central incisor along with a fused and rotated upper left central incisor in cross bite. He also had severe crowding in the maxillary arch and a congenitally missing lower right first permanent premolar. Orthodontic treatment was carried out to align upper right and left central incisors, lateral incisors, and canines. Treatment options were discussed.     

Developmental dental alterations in permanent teeth after intrusion of the predecessors: clinical and microscopic evaluation

Abstract – This case report describes the management of developmental dental alterations in permanent dentition as a consequence of severe intrusive luxation in its predecessors in a child of 2 years. At 10 years of age, this patient was referred for consultation due to lack of permanent maxillary right central and lateral incisors. Radiographic examination revealed impaction of hypoplasic permanent maxillary central incisor, absence of the lateral incisor and compound odontoma in region of the permanent maxillary lateral incisor. The odontoma was surgically removed and unerupted central incisor was placed in orthodontic traction over a period of 8 months. The central incisor presented with abnormal shape and was restored with composite resin. Odontoma histologic analysis was carried out through Hematoxylin and Eosin coloration and Scanning Electron Microscopy. Cement and osteocement formations were found in soft tissue, as well as some irregularly distributed dentine islands of tooth‐like structures, indicative of compound odontoma. We followed up this patient for 5 years and orthodontic management was successfully performed for correct alignment of the maxillary right central incisor impacted by compound odontoma.     

Mini-implant anchorage for a skeletal class II malocclusion with missing mandibular incisors: a case report

This case report describes the treatment of an adult female with a severe Class II malocclusion and congenitally missing mandibular incisors. It was decided to extract the maxillary first premolars and use mini-implants for en masse retraction of the maxillary anterior teeth. More than 13 mm of maxillary incisor retraction was obtained, with little change in the mandibular incisor inclination. The patient's facial esthetics showed dramatic improvement. The upper and lower lips were retracted by 6 mm and 7 mm, respectively. This helped reduce the mentalis strain and improve chin projection. In the mandibular arch, the canines were reshaped to substitute for lateral incisors and the first premolars were used as canines. After 25 months of retention, the results have been maintained. In this report, mini-implants proved to be an effective alternative to orthognathic surgery.     

Management of intrusive luxation of maxillary incisors with dens in dente: a case report

Abstract – Intrusive luxation is one of the most severe types of dental traumatic injuries. The risk of occurrence of pulpal necrosis and inflammatory or replacement resorption is high. In an attempt to prevent or delay the appearance of such lesions, endodontic intervention is required soon after the occurrence of trauma. A 17‐year‐old boy reported to the Department of Conservative dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, 2 days after a fall from a bicycle. Clinical and radiographic examination revealed an intrusive luxation of the left maxillary central incisor and lateral incisor. There were complicated crown fracture with the right maxillary central incisor and uncomplicated crown fracture with the left maxillary central incisor. Also, all the incisors showed the presence of Oelhers type II Dens‐in‐dente. The management was hence challenging. Immediate surgical repositioning was performed and the teeth were stabilized with a composite resin splint. Endodontic therapy was initiated with the right maxillary central incisor, and the canal was sealed with calcium hydroxide dressing. After 3 weeks, pulp sensitivity was repeated with the maxillary left central and lateral incisors. The result was negative. Considering the incidence of pulp necrosis and root resorption in intruded teeth with complete root formation, they also were dealt in a similar manner as the maxillary right central incisor. The splint was removed after 1 month. After 6 months of calcium hydroxide therapy, there was a satisfactory apical and periodontal healing. At this stage, the teeth were obturated and the fractures were restored with composite resin. A 1‐year follow up revealed a satisfactory clinical and radiographic outcome.     

Long-term follow-up of conservative treatment of severely traumatized maxillary incisors

Abstract We present the case of a 26-year-old man who at the age of 9 suffered severe trauma to both maxillary central incisors. The underlying malocclusion was skeletal and classified as dental Class II/1 with severe crowding. Both the maxillary central incisors and the two lower first premolars were extracted and the patient was treated with an edgewise appliance for 2 years. Acceptable occlusal relationships were achieved following orthodontic and adjunctive treatment which consisted of reshaping the maxillary lateral incisors with composite materials and grinding the canines to resemble lateral incisors. A critical evaluation of the esthetic and functional results at the age of 26 years is presented.     

Esthetic improvement in the patient with one missing maxillary central incisor restored with porcelain laminate veneers

This article describes esthetic improvement in a patient with a missing maxillary left central incisor. Space analysis of the anterior dentition showed that minor tooth rearrangement was needed. Optimal space distribution for restorations was attained by orthodontic treatment. Through transforming tooth shape with porcelain laminate veneers, the maxillary left lateral incisor was transformed into central incisor and the maxillary left canine into a lateral incisor. The maxillary right central incisor was also restored for esthetic improvement. In a case of changing a tooth shape with porcelain laminate veneers, pre-treatment evaluation, space analysis and diagnostic wax-up are important factors.     

Treatment of class II malocclusion with open bite and absence of central maxillary incisor lost by trauma aided by use of orthodontic mini‐implants

The aim of this article is to report the clinical case of non‐surgical treatment of a Class II malocclusion with anterior open bite, associated with absence of a maxillary central incisor avulsed due to trauma. Treatment proceeded with the use of orthodontic mini‐implants as an anchorage device for intrusion of the maxillary molars and for mesial movement of the lateral incisor to replace the central incisor. Treatment resulted in good occlusion, with anterior and lateral guides, enhancement of the facial profile, and good dental esthetic appearance without the need for prosthetic treatment. The treatment outcome was satisfactory but needs long‐term or permanent retention.     

Root canal treatment of a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement: a case report

AIM: To present the successful endodontic management of a maxillary lateral incisor tooth with a periradicular lesion caused by unintentional root damage after orthodontic miniscrew placement. SUMMARY: A 22-year-old female was diagnosed with a skeletal Class II, Division 2 malocclusion with Class II molar and canine relationships on both sides. The treatment plan included distalization of the maxillary first molars bilaterally followed by full fixed appliance therapy. For the maxillary molar distalization, an appliance in conjunction with a miniscrew anchorage system was designed. Two months later, the patient came to the clinic with complaints of pain in the maxillary right lateral incisor region. On intraoral examination, intraoral sinus tracts were detected in the maxillary right buccal sulcus and palate. A large radiolucent lesion with a well-defined margin around the root of the maxillary right lateral incisor was seen. Root canal treatment was performed on the maxillary right lateral incisor tooth. The root canal was filled with gutta-percha and AH Plus sealer, using a lateral compaction technique. The final restoration of the tooth was completed using composite, and the tooth was reviewed after 10 months. The tooth was asymptomatic and radiographically showed repair of the lesion. Healing was achieved without any need for further endodontic or surgical intervention. Key learning points ? This case illustrates the need to take care with miniscrews when performing orthodontic treatment, especially when the miniscrews are in close proximity to root apices. ? The periradicular lesion as a result of miniscrew damage was successfully treated with root canal treatment.     

Substitution of a transposed premolar for a congenitally absent lateral incisor

The purpose of this report is to review the orthodontic treatment of a patient with bilateral transposition of maxillary canines and first premolars in addition to congenital absence of a maxillary lateral incisor. This unique combination of factors led to substitution of the maxillary left first premolar for the left lateral incisor. The occlusal fit, gingival form, and esthetic appearance of premolar/lateral incisor substitution are discussed.     

Class II,Division 1, case with multiple treatment challenges

This is a case report of a 23-year-old black woman with a skeletal Class II Division 1 malocclusion and an anterior open bite. The maxillary central incisor root was severely dilacerated, a maxillary lateral incisor and canine were transposed, a maxillary canine was impacted near the orbital rim, and a mandibular secong premolar was congenitally missing. Selective extractions and attention to detail provided outstanding occlusal function and improved facial esthetics. (Am J Orthod Dentofacial Orthop 1999;115:148-52)     

Skeletal Class III Malocclusion with Unilateral Congenitally Missing Maxillary Incisor Treated by Maxillary Protractor and Edgewise Appliances

This case report describes the orthodontic treatment of a 10-year-old female patient with a combination of Angle Class III malocclusion, a missing maxillary right lateral incisor, a supernumerary tooth with a short root on the lingual side of the maxillary incisor, a skeletal Class III jaw base relationship caused by a diminutive maxilla, and retroposition of the maxilla. We chose to close the space of the missing tooth, as well as the space created by extraction of the maxillary lateral incisor, by forward movement of the canine and premolars using a maxillary protractor with edgewise appliances. As a result, both the maxillary premolars and the molars were moved mesially, and a Class II molar relationship with tight interdigitation was achieved. Our results suggest that the combination of maxillary protractor and nontorque brackets was effective not only for correcting skeletal Class III malocclusion, but also for forward movement of the maxillary posterior teeth.     

Isolated vertical infrabony defects treated by orthodontic tooth extrusion

It has been reported that periodontal disease and traumatic occlusion may cause an isolated vertical infrabony defect. In such cases, the improvement of both inflammation and the occlusion are necessary to ameliorate the defect. We discuss the successful orthodontic treatment of an adult patient with isolated vertical infrabony defects of the maxillary right lateral incisor, left canine, and mandibular left incisor regions. The patient showed an anterior crossbite and one- and two-wall wide isolated vertical infrabony defects. The inflammation was improved by a periodontist; however, the vertical infrabony defects remained. In order to improve the defects, the pulps of the maxillary right lateral incisor, left canine, and mandibular left incisor were extirpated, and temporary crowns were put on those teeth. Next, an edgewise appliance was applied to the maxillary and mandibular teeth. After the anterior crossbite was improved, the incisor edge regions of the temporary crowns were ground, and the maxillary right lateral incisor, left canine, and mandibular left incisor were extruded until they touched antagonistic teeth. The patient's anterior crossbite, traumatic occlusion and gingival esthetics were improved by this treatment. Panoramic and dental radiographs after treatment also showed improvement of the vertical infrabony defects. Thus, tooth extrusion might be effective to improve one- and two-wall wide isolated vertical infrabony defects.     

Clinical management of the congenitally missing maxillary lateral incisor and mandibular second premolar: a clinical perspective

The decision to close maintain, or open space at the agenesis sites of the maxillary lateral incisor and mandibular second premolar is generally based on several factors, including the class of malocclusion, skeletal pattern (divergence), esthetics, function, and periodontics. Replacement of congenitally missing maxillary lateral incisors, the second most commonly missing teeth, can involve (1) canine replacement, (2) tooth-supported restoration, and (3) implants. This paper contrary to the opinion of other authors, favors replacement of the congenitally missing lateral incisors in one of several ways, versus orthodontic space closure.