Reto multidisciplinario ante fractura vertical / Multidisciplinary challenge in a patient with a vertical fracture

Resumen Introducción: La extrusión rápida ortodóntica puede usarse como alternativa para evitar extraer una pieza fracturada que no podría ser restaurada por trauma, caries extensas, problemas periodontales (dos o tres paredes), dientes con reabsorción interna y dientes con perforaciones endodónticas. Objetivo: De este caso clínico es presentar a todos los odontólogos una solución sencilla de tratamiento integral de un paciente el cual sufrió un trauma facial, causándole una fractura vertical a nivel del tercio medio radicular del incisivo central superior derecho. Método: Mediante una extrusión ortodóntica, retratamiento endodóntico y abordaje periodontal, de manera que facilite la futura rehabilitación con corona completa. El resultado de este procedimiento se logró con mucho éxito gracias a que concluimos que se trató en forma multidisciplinaria, en donde cada especialidad actúa o interviene en un momento preciso. Conclusiones: La extrusión rápida es un procedimiento en el cual una pieza que ha sufrido una fractura radicular a nivel marginal puede ser tratada sin necesidad de realizar un alargamiento de corona comprometiendo así el nivel del hueso de la pieza.

Abstract Introduction: Rapid dental orthodontic extrusion may be used as an alternative to avoid the extraction of fractured teeth that might not be suitable for restauration because od trauma, extensive cavities, periodontal problems (two or three walls), teeth with internal resorption, or with endodontical perforations. Objective: Of this clinical case is to present to all dentists a simple solution of integral treatment of a patient who suffered trauma to his face causing a vertical fracture at the level of the middle third root of the right upper central incisor. Methods: Used in this case was through orthodontic extrusion, endodontic retreatment and periodontal approach, so as to facilitate future rehabilitation with a full crown. The result of this procedure was achieved with great success because we conclude that it was treated in a multidisciplinary way, where each specialty intervenes at a precise moment. Conclusions: Rapid extrusion is a procedure in which a tooth that shows a radicular fracture close to it´s margin may be treated without dental crown lengthening that would risk bone level.

Orthodontic extrusion of an incisor with a complicated crown root fracture, utilising a custom-made intra-canal wire loop and endodontic treatment: a case report with 7-years follow-up.

BACKGROUND: Dental trauma is very common among children. Crown fractures represent the majority of dental trauma in the permanent dentition. Complicated crown-root fractures require a multidisciplinary approach, for long-term success. CASE REPORT: The multidisciplinary treatment of a traumatised permanent upper incisor of an 11-year-old patient that sustained a complicated crown root fracture, while under active orthodontic treatment is presented. The pulp was widely exposed and therefore endodontic treatment was necessary. However most of the crown (and part of the coronal part of the root as well) had been fractured and the tooth could not be properly isolated for an aseptic procedure. METHODS: Orthodontic extrusion was decided and it was achieved using a custom-made, intra-canal wire loop that was cemented in the root canal and attached to the patients' orthodontic fixed appliances. RESULTS: The remaining tooth structure was successfully extruded coronally and following endodontic treatment (under proper rubber dam isolation [RDI]), root canal obturated using the cold gutta-percha technique (in order to avoid further trauma to the periodontal ligament, if a warm obturation technique was chosen) and subsequently restored under RDI. At the 7-years follow-up, no signs of clinical or radiographical inflammation were evident. CONCLUSIONS: A custom wire loop as an anchoring site is an easy-to-adopt-and-perform option for such cases. Cold gutta-percha obturation techniques should be opted for root canal obturation to avoid further trauma to the periodontal ligament.

Retrospective evaluation of treatment time and efficiency of a predictable cantilever system for orthodontic extrusion of impacted maxillary canines.

INTRODUCTION: Orthodontic extrusion of impacted maxillary canines requires careful biomechanical planning and the use of physiologic force. The aim of this study was to evaluate the time needed for orthodontic extrusion of impactions of different severities, using a device that can predictably apply forces under 0.6 N. METHODS: Twenty-two patients who were consecutively treated were selected retrospectively, and a total of 30 impacted canines were studied. Indexes of impaction were used to measure severity on pretreatment panoramic radiographs. Statistical analysis was used to detect interactions between treatment time, complexity of impaction, age, and sex. RESULTS: Treatment time was highly dependent on the patient's age; the shortest treatment time was observed in 11- to 12-year old patients. On the other hand, the severity of impaction had no effect on treatment time. CONCLUSIONS: Applying physiologic force with the proposed device resulted in a short treatment time, which depended on the patient's age more than the impaction complexity. Few complications were associated with use of this device. Future prospective studies are needed to replicate these findings and confirm the recommended use of this device.

Predictable method to deliver physiologic force for extrusion of palatally impacted maxillary canines.

INTRODUCTION: Orthodontic treatment of palatally impacted maxillary canines raises many difficulties; to minimize complications, careful planning of orthodontic extrusion and the use of physiologic force are crucial. The aim of this study was to quantitatively evaluate a simple and reproducible system for orthodontic extrusion of impacted canines that can provide the correct amount of force. METHODS: Ten specimens were constructed, consisting of a cantilever made with a 0.6-mm or 0.7-mm stainless steel wire modeled around a transpalatal bar with 3, 5, or 7 loops in the shape of a helical torsion spring. A mechanical testing machine was used to measure the force produced by the cantilever at 3, 6, 9, 12, and 15 mm of activation. RESULTS: The force values ranged from 1.24 ± 0.13 N for the 0.7-mm wire with 3 loops to 0.48 ± 0.04 N for the 0.6-mm wire with 7 loops. The forces measured for the 0.6-mm wire with 3 loops and the 0.7-mm wire with 7 loops were similar at 15 mm of deflection. CONCLUSIONS: The proposed system has a simple and robust design, is easy to construct and manage, and can provide the desired amount of force by changing the wire diameter and number of loops.

Forced eruption of a palatally impacted and transposed canine with a temporary skeletal anchorage device.

Treatment of palatally impacted and transposed canines is challenging for both orthodontists and oral surgeons. To treat a maxillary canine impaction without risking damage to adjacent teeth, it is necessary to use cone-beam computed tomography for proper localization and treatment planning. In this case report, a palatally impacted canine was initially retracted distally with a microimplant inserted in the palatal slope and then was moved buccally into its ideal position. The patient's occlusion and smile esthetics were significantly improved after orthodontic treatment.

Effectiveness of Nd:YAG Laser Fiberotomy in Clinical Crown Lengthening by Forced Eruption.

Crown lengthening by forced eruption is usually followed by conventional surgical procedures. The aim of the present study was to evaluate clinical use of Nd:YAG laser fiberotomy in crown lengthening by forced eruption as an alternative to surgery. Patients who needed crown lengthening were enrolled in this prospective case series and underwent forced eruption. Fiberotomy by Nd:YAG laser was performed 2 days after initiation of forced eruption and every 2 weeks afterward to reach optimum clinical crown length. Measurements included sulcus depth (SD), distance between the gingival margin and the acrylic stent (GM-S), distance from the dental tissue to the gingival margin (clinical crown length) (DT-GM), and distance from the top of the alveolar bone crest to the stent (AC-S) at the mesiofacial, midfacial, distofacial, and midlingual surfaces. A total of 20 patients (9 men and 11 women) with a mean age of 35.25 were enrolled. The SD, GM-S, and AC-S did not change significantly after fiberotomy (P = .32, P = .33, and P = .08, respectively). The DT-GM increased significantly following fiberotomy (P = .001). The results of this study showed that the location of the gingival margin and alveolar bone crest remained unchanged following fiberotomy by Nd:YAG laser during forced eruption, and that Nd:YAG laser can be used as a proper method for fiberotomy in such procedures.

Extrusion of severely impacted mandibular first molar using partial orthodontics and temporary anchorage miniscrews.

BACKGROUND: This study reports a case in which a severely impacted lower first molar was recovered with a combined orthodontic therapy and minimally invasive oral surgery with special focus to patient's aesthetic demands. CASE REPORT: A 12-year- old female patient was complaining delayed eruption of mandibular right first molar. Radiographic exam showed a severe tooth impaction with a close relationship between tooth roots and mandibular nerve. As the patient refused full arches orthodontic treatment, a partial orthodontic approach was projected. During treatment, temporary miniscrews were placed in both upper and lower arches, in order to allow dental movement with maximum anchorage. After a 24 month-therapy the tooth was extruded, so the appliance and the miniscrews were removed. CONCLUSION: The present case shows that severe tooth impaction can be resolved with a combined partial orthodontic- minimally invasive surgical treatment.

Combined Surgical Removal of a Supernumerary Tooth and Orthodontic Traction of an Impacted Maxillary Central Incisor.

Impaction of permanent maxillary central incisors is a rare condition that can affect esthetics and oral function. The etiology of impaction is multifactorial and may be related to embryologic reasons, hereditary factors, mechanical obstacles, and pathologic elements, such as the presence of supernumerary teeth. The purpose of this report is to discuss the case of a 10-year-old patient who presented an impacted permanent maxillary right central incisor due to a supernumerary tooth. Surgical removal of the supernumerary tooth and orthodontic traction of the impacted central incisor by the closed eruption technique were performed. After 12 months, the permanent maxillary right central incisor was adequately positioned in the arch. The multidisciplinary treatment allowed the functional and esthetic rehabilitation to happen in a short period of time, thus reducing the patient's psychological impact caused by the lack of an anterior tooth.