Managing the patient with missing or malformed maxillary central incisors

Long-term follow-up of a patient with deepbite and severely resorbed maxillary central incisors treated by maxillary premolar and mandibular incisor extraction

Deepbite is a common type of malocclusion, but it leads to difficulties in treatment and retention. We report the treatment of an adult patient with deepbite and severe crowding of teeth. Several teeth had to be restored, and the maxillary central incisors had short roots. Various treatment plans were considered, and extraction of the maxillary right and left first premolars, and mandibular right central incisor was planned. Successful treatment results were obtained with long-term retention.

Unraveling Impacted Maxillary Incisors: The Why, When, and How

Failure of eruption of maxillary incisors requires careful diagnosis and treatment planning. The cause of impaction may vary from physical obstruction in the path of eruption, tooth material arch length discrepancy to malformation of the tooth. General principles of management of the condition include removal of physical obstruction, creation of space, and surgical exposure with or without traction. The treatment of an unerupted tooth depends upon its age, position, etiology, and amount of space in the dental arch. This case series elaborates on three different cases of incisor impaction with different etiologies and varying ranges of complexity. Three-dimensional radiography was utilized in all cases to accurately visualize the impacted tooth and its relation to adjacent structures. All the cases required different approaches and were completed in varying time durations. Meticulous treatment planning resulted in well-aligned satisfactory functional and esthetic results.

How to cite this article: Jain S, Raza M, Sharma P, et al. Unraveling Impacted Maxillary Incisors: The Why, When, and How. Int J Clin Pediatr Dent 2021;14(1):149–157.

Comprehensive orthodontic treatment in an adolescent patient with Class II Division 1 malocclusion and ankylosed maxillary central incisors

While uncommon in orthodontics, the extraction of central incisors may be indicated when such teeth are of poor prognosis. This report details orthodontic treatment of a 13-year and 5-month-old Chinese female, who presented with Class II/1 malocclusion on a Class II skeletal jaw base relationship. Her maxillary central incisors were ankylosed and had undergone severe external root resorption following a previous traumatic episode. Orthodontic treatment involved removal of the maxillary central incisors and the mandibular first premolars. Pre-adjusted edgewise appliances with MBT prescription were used. To enhance anterior esthetics, prosthetic buildup of the four maxillary anterior teeth was performed before appliance removal. Tight intercuspation of teeth and optimal facial esthetics were achieved at appliance debond and maintained at 2-year follow-up.

National clinical guidelines for the management of unerupted maxillary incisors in children

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

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.

The Management of the Dilacerated Impacted Maxillary Central Incisor

The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available − orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples. Clinical relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.

Review of Dilaceration of Maxillary Central Incisor: A Mutidisciplinary Challenge

Traumatic injuries to primary dentition may interfere with the development of permanent dentition. Among the many malformations, dilaceration is particularly important to the clinician. Management of dilacerated maxillary central incisor requires a multidisciplinary approach. The main purpose of this review is to present the etiological factors, the mechanism, clinical features, radiographic features and treatment of dilaceration of the maxillary central incisors. How to cite this article: Walia PS, Rohilla AK, Choudhary S, Kaur R. Review of Dilaceration of Maxillary Central Incisor: A Multidisciplinary Challenge. Int J Clin Pediatr Dent 2016;9(1):90-98.

Communication practices and preferences between orthodontists and general dentists

OBJECTIVE

To evaluate similarities and differences in orthodontists' and general dentists' perceptions regarding their interdisciplinary communication.

MATERIALS AND METHODS

Orthodontists (N  =  137) and general dentists (N  =  144) throughout the United States responded to an invitation to participate in a Web-based and mailed survey, respectively.

RESULTS

The results indicated that orthodontists communicated with general dentists using the type of media general dentists preferred to use. As treatment complexity increased, orthodontists shifted from one-way forms of communication (letters) to two-way forms of communication (phone calls; P < .05). Both orthodontists and general dentists reported that orthodontists' communication regarding white spot lesions was inadequate. When treating patients with missing or malformed teeth, orthodontists reported that they sought input from the general dentists at a higher rate than the general dentists reported (P < .005).

CONCLUSIONS

Orthodontists' and general dentists' perceptions of how often specific types of media were used for interdisciplinary communication were generally similar. They differed, however, with regard to how adequately orthodontists communicated with general dentists and how often orthodontists sought input from general dentists. The methods and extent of communication between orthodontists and general dentists need to be determined on a patient-by-patient basis.

Extraction of maxillary central incisors: an orthodontic-restorative treatment

Malformed central incisors with poor prognosis could be candidates for extraction especially in crowded dental arches. This case report refers to a 12-year-old boy who suffered from malformed upper central incisors associated with severe attrition. Upper lateral incisors were positioned palatally and canines were rotated and positioned in the high buccal area. The patient had class II malocclusion and space deficiency in both dental arches. Due to incisal wear and malformed short maxillary central incisors and the need for root canal therapy with a major crown build-up, these teeth were extracted. The maxillary lateral incisors were substituted. Thus the maxillary canines were substituted for lateral incisors and the first premolars were substituted for canines. In the lower dental arch the first bicuspids were extracted. Composite resin build-up was performed on the maxillary lateral incisors and canines. This allowed for the crowding and the malocclusion to be corrected. Subsequent gingivectomy improved the patient's gingival margins and smile esthetics one month after orthodontic therapy.

Treatment strategies for missing maxillary central incisor--an orthodontist's perspective

The loss of maxillary central incisors at an early age has psychological, esthetic, and functional implications. Multiple treatment options are available for replacing missing central incisors. The management demands a multidisciplinary approach involving the orthodontist, prosthodontist, and periodontist. Treatment planning requires consideration of a variety of clinical and nonclinical factors. This clinical report attempts to demonstrate different strategies for the management of unilaterally and bilaterally missing central incisors.

Traumatic loss of a maxillary central incisor treated with nonextraction orthodontics

This case report describes the orthodontic treatment of a girl who lost her maxillary left central incisor from trauma. The patient had a concave profile, a Class I molar relationship on the right side and a Class II molar relationship on the left side, with a slight maxillary retrusion, an anterior edge-to-edge bite, and a posterior crossbite. Therefore, the treatment consisted of rapid palatal expansion to widen the maxilla in a transverse direction along with reverse headgear to improve the incisor relationship. The crown of the left canine was modified to resemble the left lateral incisor, and a porcelain veneer was placed to make the left lateral incisor resemble the left central incisor. This case report illustrates how orthodontics alone can be used to treat a missing central incisor, without a bridge or an implant.

[Central incisor and individualizing treatment of the smile due to orthodontics]

The objectives of the orthodontic treatment that we provide are to re-establish functional occlusion and a harmonious facial appearance, taking the individual anatomic features of each patient into account as well the potential changes that will come with ageing. As a pre-treatment first step we analyze the position of the incisor teeth within the face. Next we pose several questions. Should we preserve a slight bi-maxillary protrusion or correct it? Should we decide to voluntarily maintain a slight supraclusion? When should we correct a gummy smile? What should we do about black holes? In this article we propose treatment approaches, illustrating them with clinical situations and focus on the critical role played by the central incisor in establishing smiles that are suitable for each patient, integrating them with the ageing patterns that we know the future will bring.

2 '2' 1: Orthodontic repositioning of lateral incisors into central incisors

The clinical problem of how best to manage an anterior space resulting from a missing central incisor will only be encountered rarely. The goal should be to deliver treatment results that are indistinguishable from normal appearance. This article describes one treatment approach - orthodontic space closure with substitution of the maxillary central incisor by the lateral incisor. Treatment indications, orthodontic and restorative considerations, advantages and disadvantages, as well as the evidence base relating to this treatment modality will be presented and supported by two clinical case examples.

Effect of different methods for decontaminating tooth enamel after contact with blood before bonding orthodontic buttons

PURPOSE

To evaluate the best method for decontaminating tooth enamel contaminated by contact with blood before bonding orthodontic buttons.

MATERIALS AND METHODS

The labial surfaces of 195 bovine incisors initially received prophylaxis, followed by 37% phosphoric acid etching, adhesive application, and light polymerization. After this, the labial surfaces of all teeth were contaminated with blood. The teeth were then randomly divided into 13 groups (n = 15), comprising the control group (treated according to the manufacturer's recommendations) and 12 experimental groups treated by the following decontamination methods: group 1, no decontamination; group 2, washing with distilled water; group 3, washing with physiologic solution; group 4, jets of air; group 5, gauze; group 6, cotton wool; group 7, distilled water plus jets of air; group 8, distilled water plus gauze; group 9, distilled water plus cotton wool; group 10, physiologic solution plus jets of air; group 11, physiologic solution plus gauze; and group 12, physiologic solution plus cotton wool.

RESULTS

No statistical differences were shown between the control group and groups 4, 7, 10, and 11 (P > .05). The lowest bond strength values were shown in group 1, in which no decontamination was performed, and groups 6 and 12, which were decontaminated with cotton wool and physiologic solution plus cotton wool, respectively.

CONCLUSIONS

The best method of decontaminating enamel contaminated with blood is washing with physiologic solution, followed by drying with jets of air and gauze or drying with jets of air only.

Anterior fixed interim prosthesis with natural tooth crown as pontic subsequent to replantation failure

Facial trauma resulting in tooth avulsion results in problems of physical and emotional nature for the patient and a challenge for the dentist. Avulsion accounts for 0.5–16% of traumatic injuries in the permanent dentition that can occur at any age and is most common in the young permanent dentition. As an emergency procedure, it is advisable to replant a traumatically avulsed tooth, but unfortunately long-term success is rather low. After unsuccessful replantation and subsequent extraction, it is prudent to replace the lost tooth to avoid aesthetic, masticatory, and psychological difficulties and also to prevent arch length discrepancy with various alternatives are available for the same. We presented a method for management of one of the two replanted teeth that showed failure, using the natural crown as pontic in a fixed semi-permanent bridge until a more definitive prosthesis can be fabricated at a later age for better patient compliance.

Orthodontic movement of a maxillary incisor through the midpalatal suture: a case report

Orthodontic space closure is a treatment alternative when a maxillary central incisor is missing. The objective of this report was to present an unusual treatment in which a right maxillary central incisor was moved through the midpalatal suture to replace the absent contralateral tooth. The biologic aspects and clinical appearance of the recontoured lateral and central incisors were analyzed. The position of the examined teeth and the appearance of the surrounding soft tissues were satisfactory; however, the upper midline frenulum deviated to the left. The incisor was successfully moved with no obvious detrimental effects as observed on the final radiographs. In the radiographic and tomographic examinations, the midline suture seemed to have followed the tooth movement. The patient expressed satisfaction with the results. It was concluded that orthodontic movement of the central incisor to replace a missing contralateral tooth is a valid treatment option, and the achievement of an esthetic result requires an interdisciplinary approach, including restorative dentistry and periodontics.

Multidisciplinary solution for an avulsed upper central incisor: case report

This case report refers to an 18-year-old female who suffered from dental trauma when she was 7 years old caused by a bicycle accident. Her maxillary right central incisor was avulsed, and the left one was extrusively luxated. The left central incisor was correctly repositioned and immobilized with a semi-rigid splint. The right one could not be found. She presented with class II malocclusion and severe negative arch-length discrepancies in both arches. The treatment objectives were the following: recover smile esthetics by replacing the maxillary right central incisor, correct the class II relationship, and optimally reduce mandibular and maxillary crowding. Extractions of the maxillary left lateral incisor and the lower right first bicuspid were performed; thus, the maxillary right lateral incisor would function as a maxillary right central incisor, the canines would function as lateral incisors, and the first bicuspids would function as canines. This allowed for the malocclusion to be corrected while simultaneously reestablishing the smile esthetics, without the use of an osseointegrated implant. A good occlusion with coincident upper and lower midlines was achieved. After orthodontic therapy, the patient underwent periodontal surgery to improve her gingival margins. Subsequent teeth bleaching was performed, and the patient received six porcelain veneers. A combination of orthodontic space closure and prosthetic rehabilitation may be the best treatment option after severe traumatic tooth loss.

Moving an incisor across the midline: a treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement.

Space closure after extraction of two central upper incisors and re-shaping of laterals

A 13-year-old boy had fractured both maxillary central incisors when he was 8 years old, resulting in pulpar damage. At the time of the accident, root canal therapy was performed. Although the teeth were retrieved, their roots were short and not fully developed. Cephalometric analysis suggested extraction of the four first premolars to achieve aesthetic and functional objectives. To attend to the patient's chief complaint, and with his parents' approval, both upper central incisors were extracted followed by periodontal and cosmetic procedures to improve the patient's smile as well as his self-esteem and satisfaction.

Evaluation of panoramic radiographs taken at the initial visit at a department of paediatric dentistry

OBJECTIVES

To examine oral and maxillofacial lesions other than those related to the chief complaint in panoramic radiographs taken at the department of paediatric dentistry at our hospital.

METHODS

We retrospectively reviewed all 1092 patients who had visited the department of paediatric dentistry at our hospital and had a panoramic radiograph taken between August 1999 and October 2004. The following information was obtained from the patients' files and panoramic radiographs: gender, age, chief complaints and the presence or absence of lesions.

RESULTS

Lesions were observed in 140 of the 1092 panoramic radiographs (12.8%). Among the 140 patients discovered to have lesions in the panoramic radiographs, 66 (47.1%, or 6.05% of the entire group of 1092 patients) had different lesions from those underlying the chief complaint. These 66 patients ages ranged from 3 years to 14 years and the lesions involved 39 (59.1%) missing teeth, 20 (30.3%) mesiodentes, 4 supernumerary teeth, 1 odontoma, 1 radicular cyst and 1 impacted tooth. The missing teeth were observed in the central and lateral incisor, canine, and first and second premolar positions of both jaws, especially in the lower lateral incisor and upper central incisor positions.

CONCLUSIONS

We were able to detect incidental lesions at a rate of 6.05% (66 of 1092 patients) and at a relatively early age (mean 6.8 years) in the present study. Early treatment of these lesions could avoid maxillofacial deformity and other complications.

Time of endodontic treatment in autogenic transplants of mature teeth: Histological study in dogs

OBJECTIVE

Root canal therapy is often recommended after mature tooth transplantation. The aim of this work was to histologically evaluate, in dogs, the best time for root canal treatment in autogenic transplants of teeth with complete root formation.

STUDY DESIGN

Mandibular lateral incisors of 8 dogs were extracted and transplanted to the homologous alveolus, endodontically treated after 15 (Group I) or 40 (Group II) days, and processed for routine histological evaluation. Tissue responses on the root surface were evaluated by light microscopy and classified as normal periodontium, active inflammatory root resorption, favorable healing, and unfavorable healing.

RESULTS

The mean of normal periodontal tissue was in 88.6% in Group I and 79.4% in Group II. There were no significant statistical differences between the groups in all analyzed parameters.

CONCLUSION

The results indicated that endodontic therapy can be postponed for 40 days postoperatively when the tooth stability is higher.