114 SURGICAL UNCOVERING AND STIMULATION OFPHYSIOLOGICAL ERUPTION OF P - PDF document

114 SURGICAL UNCOVERING AND STIMULATION OFPHYSIOLOGICAL ERUPTION OF PALATALLYIMPACTED MAXILLARY CANINES: CASE REPORTSMiroslava Yordanova, Svetlana Yordanova , B. Vladimirov Department of Maxillofacial Surgery,Faculty of Dental Medicine, Medical University - Plovdiv, Bulgaria Journal of IMAB - Annual Proceeding (Scientific Papers) vol. 17, book 2Introduction. The orthodontist treating patients withcase reports the potential of the open surgical technique forMaterial and methods. Three patients aged 13 to 20Results and discussion. All canines underwentConclusion. The described method of surgical palatally impacted canines, surgicalTreatment approaches are aimed at the canines’ correctand can be divided into preventive and surgical. Theand prevention of impaction is impossible surgical-Various surgical techniques for exposing palatallywindow; 4. tunnel extrusion, etc. Within the differentThe choice of a surgical approach still remains aquestion of personal preference for the surgeon andevidence in favor of one of the techniques (7, 8, 9). Additionalteeth are needed (10, 11).The aim of the present report was to demonstrate thepotential of the open surgical technique for stimulation ofMATERIAL AND METHODSThe teeth had different degrees of impaction in relation to thevertical and horizontal planes. Surgical exposure wasperformed before orthodontic treatment in one of the cases,treatment in the rest. Standard procedure for surgical-removal of bone overlying the canine’s crown from-creating a small fenestration in the flap over the diagnosed on panoramic and occlusal radiographs. ThoroughAngle’s Class I, and skeletal Class II. Intraoral palpation andimpaction of the maxillary permanent canines. The lack ofteeth 18, 38, and 48 as well as the degree of impaction ofincisor, while the right canine was located approximately atthe middle third of the root of the right lateral incisor.According to Ericson and Kurol’s classification (4) the medial13 and grade V impaction for tooth # 23. The close position Radiographs of patient D.B. aged 13 taken before surgical-orthodontic After a consultation with a maxillofacial surgeon, thepossibilities for surgical exposure and orthodontic treatmentpatient and the patient’s family. The following treatment planthen waiting for its autonomous eruption (Fig. 2 - F, G, H, 116 compressed dental arches with 2-3 mm of insufficient spacefor teeth # 13 and # 23; deep bite; Angle’s dental Class II 1palpation. The occlusal radiograph (Fig. 3) also confirmedpalatal impaction for both canines. The panoramic X-ray canines. The upper right canine was inclined and verticallyjunction of tooth # 11. Its medial position in relation to tooth# 12 correlated to grade IV impaction. The left canineThe patient was offered a treatment plan involving Radiographs of patient D.M. aged 15 taken before surgical- Tooth # 23 underwent autonomous eruption palatallytreatment (Fig. 4 - A). Due to the considerable tightness ofthe palatal mucosa surgical gingivectomy was planned toaccelerate the full eruption of the tooth (Fig. 4 - B, C). Thesurgical uncovering was applied on tooth # 13 followed byits subsequent autonomous eruption (Fig. 4 - D, E, F, G). At The patient K.T. aged 20 years sought orthodonticinvestigations found lack of tooth # 13 and insufficient space17 and # 46, 47; Angle’s dental Class I; skeletal Class IIIand slight hyperdivergent type of growth. The palatal5) was grade III of medial displacement. The crown tip of# 11 and the canine was vertically inclined.The surgical-orthodontic treatment plan involved:surgical uncovering of tooth # 13 while leveling and aligning0.22 “ (Fig 6 - A, B); waiting for the canine’s autonomous 118 Panoramic x-ray - patient K.T. aged 20 years. Stages of treatment - patient K.T. aged 20 years.RESULTSextrusion. The period of waiting for the autonomousIn case 1 the total time from surgical uncovering tofor a period of 11 months. The rest of the canines are stillDifferent surgical techniques find support or criticismin numerous investigations (5). The present report addressed- the eruption of the teeth after their surgical exposure. Thismarginal bone, gingival recessions, trauma to neighbouringtissues, etc. That is why the clinician should strive for atype of extrusion. This technique facilitates considerably thedevices carries are eliminated. The orthodontist does notroot apex (14). Such was the case with the patient K.T. agedHowever, in older patients (above 30 years) and complex Address for correspondence:Dr. Miroslava YordanovaDepartment of Orthodontics, Faculty of Dentistry, Medical University, Plovdiv2, Hristo Botev Str., 4000 Plovdiv, BulgariaOrthodontics 4th ed. Chicago,IL, Year book2. Becker A., Smith P, Behar R. Thecuspids. Angle Orthod. 1981 Jan;51(1):24- maxillary canines. Am J Orthod Dentofacial [ palatally erupting maxillary canines byOrthod 1988 Nov;10(4):283-245. [ 5. Bedoya M., Park JH. A review of themaxillary canines. J Am Dent Assoc. 2009 6. Kokich VG Preorthodontic Orthod. 2010;16: 205-211.7. Parkin N, Benson PE, Thind B, ShahA. Open versus closed surgical exposure ofthe mouth. Cochrane Database Syst Rev. [ 8. Swart RJ., Kiekens RM, Berge SJ,Kuijpers-Jagtman AM. Orthodontics ingeneral practice. 2. Treatment of eruptionfailures. Ned Tijdschr Tandheelkd. 2007Oct; 114(10): 416-22. [Article in Dutch] 9. Shafi I. No evidence to support onesurgical technique over the other for theEvid Based Dent. 2008;9(4):111. [ 10. Schmidt AD, Kokich VG.canines. Am J Orthod Dentofacial Orthop2007 Apr;131(4):449-455 doi:10.1016/ ] [ 11. Frank CA., Long M. Periodontaltreatment of impacted teeth. Am J Orthod CrossRef] [ 12. Kokich VG, Mathew DS. Impactedteeth: Orthodontic and surgicalconciderations. In: McNamara Jr, editor.Ann Arbor (Mich): Needham Press; 2001:13. Ngan P, Hornbrook R., Weaver B.erupting maxillary canines. Semin Orthod2005; 11: 152-163.14. Frank Ch A. Treatment options forimpacted teeth. J Am Dent Assoc. 2000 hard-tissue obstacles on their path are eliminated. The resultsof the use of surgical uncovering and autonomous eruption,above mentioned observation. The timely, uncomplicated