Treatment of impacted or retained second molars with the miniscrew-supported pole technique: a prospective follow-up study.

BACKGROUND: Eruption disturbances of permanent molars are uncommon; however, it is important to treat them as soon as they are diagnosed. The main objective was to analyze the effectiveness of the "miniscrew-supported pole technique," a surgically assisted orthodontic procedure to force the eruption of impacted/retained second molars (M2s) when there are indicators of complex molar inclusion. An observational prospective study was carried out during a 2-year period. Sociodemographic, clinical and low-dose scanner variables were taken at baseline (T0). Follow-up variables (T1) were the time between surgery and tooth eruption, radiographic measurements, debonding of buttons, failure rate of miniscrews and success rate of eruption. RESULTS: A total of 21 patients (mean age of 13.9 years) with 24 retained/impacted M2s were recruited; 13 molars were maxillary (54.2%) and 11 (45.8%) were mandibular. Six (25%) were impacted molars and 18 (75%) primarily retained. At T0, molar angulation was mesial in six molars (25%), distal in five molars (20.8%) and 13 molars were vertically positioned (54.2%). Infraocclusion degree was moderate in four (16.7%) molars and severe in 20 (83.3%). Only three (12.5%) third molars were removed due to lack of space. All M2s managed to erupt, achieving a success rate of 100%; however, two molars of the same patient did not achieve occlusion. The period of eruption after surgery was 126.8 (117.3) days. Anatomical radicular alteration was the only variable independently related to a longer time of treatment (p = 0.027). CONCLUSIONS: The pole technique, using one mesial miniscrew and simple orthodontic mechanics, applies forces that succeed in erupting complicated retained/impacted M2s in a short period of time and with a low failure rate.

Orthodontic management of severe iatrogenic biprotrusion and resorptions with miniscrews and corticotomies.

BACKGROUND: This case report describes a patient with severe iatrogenic dental biprotrusion who visited for a second assessment. The patient presented first premolar maxillary extractions, resorbed maxillary incisors and dehiscences in the anterior buccal and palatal cortical bone diagnosed with cone-beam computed tomography (CBCT). MATERIAL AND METHODS: At the beginning of treatment, fixed appliances were bonded on all teeth except on the upper incisors to prevent further root resorption. Mandibular first premolar extractions, miniscrews and corticotomies were scheduled for gaining distalization of the teeth in the four quadrants. When this was achieved, an occlusal splint was placed to extrude the posterior teeth with interarch elastics for increasing the vertical dimension. Next, brackets were placed on the maxillary incisors and a comprehensive orthodontic treatment was performed. RESULTS: After treatment, changes in incisor positioning were evident, varying the interincisal angle by 57.6 degrees. Nevertheless, slight root resorption of the upper incisors was observed. CONCLUSIONS: Correct diagnosis is necessary to design an adequate treatment plan and make orthodontists aware of possible severe unwanted tooth movements before they occur. In dental biprotrusion without overjet, the first objective should be to distalize mandibular teeth prior to maxillary teeth retraction.

Miniscrew-supported pole technique: Surgical-orthodontic approach for impacted or retained second molars in adolescents.

BACKGROUND: Several treatment options have been proposed for the treatment of eruption disturbances of permanent molars. Despite being an infrequent condition, these disturbances should be solved as they can lead to important complications and play a relevant role in completing the occlusion. FINDINGS: The presented cases involved maxillary and mandibular included second molars (M2s) respectively. Both teeth erupted successfully after the application of the miniscrew-supported pole technique, and a functional occlusion was established. CONCLUSIONS: This technique is a surgically assisted orthodontic procedure performed to force the eruption of impacted/retained M2s. This device uses one mesial miniscrew which allows the application of relevant force to achieve the eruption of complicated retained/impacted M2s within a short period of time.

Orthodontic management of a complete and an incomplete maxillary canine-first premolar transposition.

Maxillary canine and first premolar transposition is a complicated dental anomaly to treat, especially if the clinician's goal is to orthodontically move the canine into its normal position. Early diagnosis with cone-beam computed tomography simplifies the treatment of this pathology. This case report describes a patient with bilateral transposition, one complete and the other incomplete, involving the maxillary canine and the first premolar (Mx.C.1P). The orthodontic treatment involved the correction of both transpositions. In the complete transposition, the traction was mesial and upward to move the canine into a more apical position with a wider dentoalveolar process for easier crown interchange.

Quad-helix compression to decompensate molar inclination prior to skeletal expansion.

OBJECTIVES: To demonstrate that patients without posterior crossbite (PCB) but with maxillary transverse deficiency, not previously observed due to an increased curve of Wilson, can benefit from the same palatal expansion as patients with PCB, after correction of the buccal inclination. MATERIALS AND METHODS: A total of 41 patients presenting a maxillary skeletal transverse deficiency were treated: 26 without PCB and 15 with PCB. In the non-PCB group, quad-helix compression was followed by a Hyrax expander (QH+HY), whereas the PCB group only underwent Hyrax expander treatment (HY). The maxillary intercanine, interpremolar, intermolar widths (cusp tips and gingival level) and molar inclination were measured at baseline and at the end of treatment in both groups. RESULTS: No significant differences were found between groups at the end of treatment, and no PCBs remained. The same maxillary expansion was achieved in the QH+HY and HY groups in the region of the canines, at both the gingival (3.4 ± 2.0 vs. 3.4 ± 2.7 mm; P = 0.999) and cusp tip levels (4.5 ± 3.1 vs. 3.8 ± 2.2 mm; P = 0.981). The molar inclination in the QH+HY group decreased, while there was a slight increase in the HY group (-6.50° ± 5.34° vs. 2.3° ± 4.1°; P < 0.001). CONCLUSIONS: Some patients with maxillary transverse deficiency do not present with PCB, due to an increased curve of Wilson. However, these patients require skeletal expansion similar to that of patients with a bilateral PCB. The curve of Wilson should be flattened prior to expansion in order to increase the amount of maxillary skeletal expansion.

Surgical-orthodontic approach for facial rejuvenation based on a reverse facelift.

BACKGROUND: Orthodontic treatment combined with a maxillomandibular advancement (MMA) can be an effective option for patients who need not only corrected occlusion but also facial rejuvenation. In this case series, two patients underwent orthodontic treatment and bimaxillary orthognathic surgery involving MMA, one of them with a counterclockwise rotation of the occlusal plane (OP). FINDINGS: In both cases, the face was rejuvenated, a functional occlusion was established, and the posterior airway space (PAS) was widened. CONCLUSIONS: The facial mask ages three dimensionally. MMA should be offered to patients who have insufficient skeletal projection and are considering improving their facial appearance beyond just correcting a malocclusion problem. The reverse facelift provides more soft-tissue support, resulting in mid- and lower-face rejuvenation.

Management of Deeply Impacted Molars with the Miniscrew-Supported Pole Technique.

Impacted molars occur more often in the mandibular arch than in the maxillary arch, with an overall prevalence of .01-1.8%.(1-4) The most common type of impaction, a mesially inclined molar, is also the most successfully treated.(5) Even a horizontally impacted lower second molar can be uprighted. If a molar is diagnosed in a vertical position, however, its prognosis is more compromised and ankylosis should be suspected.(5,6).

Surgical and orthodontic management of maxillary canine-lateral incisor transpositions.

Transposition of the maxillary canine and the lateral incisor is a complex dental anomaly to treat. The difficulty increases if the treatment aims to correct the transposition. These case reports describe 2 patients with transposition of the maxillary lateral incisor and canine. The first case involves bilateral incomplete transpositions, and the second is a complete transposition. The radiographic appearance of the canine was similar in the 2 patients. However, the treatments were distinct because of the 3-dimensional positions of the teeth. The first case involved palatally placed lateral incisor roots. To prevent resorption of the lateral incisors, the canines were moved into position buccally. In the second case, the lateral incisor root had a buccal position, and the canine crown was tractioned palatally. The position of the lateral incisor root was critical when electing the correct treatment and mechanics for each patient.