J Dent Rehabil Appl Sci.  2019 Sep;35(3):180-190. 10.14368/jdras.2019.35.3.180.

Intrusion of the extruded maxillary central incisor using skeletal anchorage system and unilateral segmental intrusion arch

• Kwon EY
• Baek YJ
• Park SB
• Kim SS
• Kim YI
• Choi YK

• KMID: 2463627
• DOI: http://doi.org/10.14368/jdras.2019.35.3.180

Abstract

Patients who have a moderate periodontitis with pathologic tooth migration of maxillary incisors, it is necessary not only periodontal treatment for reduce periodontal inflammation, but also orthodontic treatment to teeth repositioning. For orthodontic treatment, it is necessary to apply less force and careful considerations of the center of resistance of the tooth and optimal force of tooth movement. At this time, the segmental arch applied only to the target teeth, is more effective and predictable, because applied force and direction can be controlled. In addition, to design the orthodontic appliance that can prevent the unwanted tooth movement that used as an anchorage is important. In recent years, various types of skeletal anchorage system have been used for preventing loss of the anchorage. We reported the patient who had extruded maxillary central incisor due to pathologic tooth migration, treated by a successful periodontal-orthodontic multidisciplinary treatment using an orthodontic appliance designed to apply less traumatic force and reduce an anchorage loss.

Keyword

periodontitis; tooth migration; tooth intrusion; orthodontic wire; orthodontic anchorage

MeSH Terms

Humans
Incisor*
Inflammation
Orthodontic Appliance Design
Orthodontic Appliances
Orthodontic Wires
Periodontitis
Tooth
Tooth Migration
Tooth Movement

Figure

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  Fig. 1 Pre-treatment intraoral photographs. (A) #21 was extruded. Large black triangle was observed between #11 and #21, (B) #21 was protruded.

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  Fig. 2 Pre-treatment panoramic (A) and periapical (B) radiographs. (A) Generalized alveolar bone loss was observed. #26 and #27 were extracted, (B) Angular alveolar bone loss was observed on the mesial root surface of # 21.

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  Fig. 3 Procedure of periodontal surgery with bone graft. (A) Deep periodontal pocket and alveolar bone loss were observed, (B) Flap design to preserve interdental papilla was designed, (C) During periodontal surgery, bovine bone graft (Bio-Oss®) materials were used for bone graft.

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  Fig. 4 Intraoral photograph before orthodontic treatment (3 months after periodontal surgery).

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  Fig. 5 Segmental intrusion arch design. (A) 0.016 × 0.025-inch TMA wire was used for segmental intrusion arch, (B) The segmental intrusion arch was designed to allow the force to pass through the center of resistance of #21.

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  Fig. 6 Intraoral photographs of orthodontic treatment (initiation, bracket bonding). The segmental intrusion arch was applied to #21 and 26. The segmental intrusion arch was activated and pulled toward bracket to apply a force of 12 gm.

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  Fig. 7 Progression of orthodontic treatment (during 5 months). #21 was gradually intruded by segmental intrusion arch.

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  Fig. 8 Post-orthodontic treatment (bracket removal) intraoral photographs. #21 was intruded and retracted. Fixed retainer was placed on maxilla anterior teeth (#13-23).

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  Fig. 9 Comparisons of pre-treatment (A, C) and post-treatment (B, D). (A, B) Intraoral photographs. #21 was intruded. The gingival margin of #21 was maintained during orthodontic treatment and black triangle between #11 and #21 was reduced. (C, D) Periapical radiographs. After orthodontic treatment, #21 was intruded.

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  Fig. 10 Intraoral photographs (A) and periapical radiograph (B) for 4-year retention period

Reference

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