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KMID : 1149720190090030151
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Clinical Journal of Korean association of Orthodontists
2019 Volume.9 No. 3 p.151 ~ p.164
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A Case Report: Orthodontic Treatment of Iatrogenic Trauma Teeth Caused by Anterior Segmental Osteotomy
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Hong Seok-Yoon
Kim Young-Ho
Chae Hwa-Sung
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Abstract
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When extraction treatment is planned in patients with lower three incisors, three premolars extraction is widely accepted. In this case report, moving traumatized teeth to close the orthodontic residual space after anterior segmental ssteotomy (ASO) will be presented. The patient underwent ASO and was referred for orthodontic treatment after three months. #14, 24, 34 was extracted, and a surgical attempt to separate #43 and #44 was noted. Upon clinical exam, teeth discoloration of #23, 33, 44 was evident. In addition, radiographs, including CT revealed that the surgical line was quite approximated to the root surface, especially to #44. No symptoms were noted. Possibility of PDL damage was suspected, regarding ankylosis and trauma. Although panorama and periapical X-rays showed poor prognosis of those teeth, CT sectioning indicated no obvious root damage. Furthermore, the patient insisted that her lips were more retracted than she expected. Thus, molars protraction to close the residual space was necessary. Clinical examination also demonstrated of 3 mm anterior open bite, lower three incisors, and residual space of 5 mm in the upper and 2 mm in the lower arch. Biomechanically, it is hard to perform molars protraction while closing anterior open bite. Maxillary incisors brackets were positioned upside-down (0.022-inch slot MBT, -17°) to increase upper incisal show and also to consider further maxillary full-arch protraction due to the patient complaint. To achieve molars protraction and intrusion simultaneously, protraction TPA with high positioned solder hooks were designed and delivered. TPA protraction was attempted first to test the possibility of ankylosis before full treatment. Superimposition revealed that the molars were successfully intruded and protracted, which contributed to the mandibular plane closing effect. A successful substitution for #43 to #42 and acceptable occlusion was obtained. Careful examination of CT sectioning helps orthodontic treatment of surgically traumatized teeth. Diagnostic molar protraction followed by active intrusion helps to achieve acceptable outcomes.
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KEYWORD
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Anterior segmental osteotomy, Trauma, Cone-beam CT, Three incisors
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