Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Archives of Oral Sciences & Research INTERCEPTION OF SEVERE ANTERIOR TOOTH ROTATION AND CROSS BITE IN THE MIXED DENTITION- A CASE REPORT. Suresh K.S.*, Nagarathna J**. ABSTRACT This is a case report of an, 11 year old boy of mixed dentition age with class I malocclusion presented with severe rotation of upper left central incisor and single tooth anterior crossbite with inadequate space for their alignment. First premolar and retained deciduous lateral incisor were extracted followed by fixed orthodontic treatment which resulted in correction of single tooth cross bite and rapid correction of severly rotated tooth within three months. AOSR 2013; 3(1): 76- 83 Keywords: Dental cross bite, mixed dentition, fixed orthodontic treatment. * Professor and Head of the department, Pedodontics & Preventive Dentistry, Government Dental College & Research Institute, Bangalore – 560002, India. ** Lecturer, Department of Pedodontics & Preventive Dentistry, Government Dental College & Research Institute, Bangalore – 560002, India. and disturbances related to position.2 INTRODUCTION Recognizing conditions, which Tooth rotation is one among the eruption predispose to malocclusion in young disturbances related to position which children, is an important part of any poses greater difficulty for correction comprehensive dental more so, if Interceptive treatment is compounded 1 assessment. pediatric the tooth in rotation is with adjacent tooth usually carried out in order to reduce the malposition and inadequate space in the severity of a developing malocclusion. arch. The period of mixed dentition offers the Tooth rotation can be defined as greatest observable mesiolingual or distolingual guidance opportunity and for occlusal interception of intra alveolar displacement of the tooth malocclusion. around its longitudinal axis.3 A rotated Eruption disturbances can be broadly upper central incisor can be corrected by classified as disturbances related to time a removable orthodontic appliance with 76 Anterior tooth rotation & cross bite minimal force but severe rotation with inadequate arch length, a habit of biting adjacent the upper lip. tooth malposition and inadequate space within the arch for Anterior cross bite may lead to abnormal their alignment are difficult to correct. enamel abrasion of the lower incisors, Many rotations are associated with an dental element of apical displacement and will incisors leading to thinning of labial be difficult to correct with removable alveolar plate, and/or gingival recession. appliance.4 Anterior dental cross bite requires early Anterior cross bites are commonly and immediate treatment to prevent encountered malocclusion, anterior discrepancy in the due the buccolingual compensation teeth periodontal of mandibular mobility, fracture, pathosis, and relationship of the upper and lower temporomandibular joint disturbance. 6-12 teeth.5 Graber has defined cross bite as a Lee13 outlined four factors to consider condition, where one or more teeth may before selecting a treatment approach be abnormally malposed either lingually 1. Adequate space in the arch to or labially with reference to opposing reposition the tooth teeth. Anterior dental cross bite has a 2. Suffcient overbite to hold tooth in reported incidence of 4-5% and usually position following correction becomes evident during the early mixed- 3. An apical positioning of the tooth in dentition phase.6-9 cross bite The anterior cross bite may result from 4. A class I occlusion variety of factors such as lingual The main goal of treatment is to tip the eruption path of the maxillary anterior affected maxillary tooth or teeth labially incisors, a repaired cleft lip, trauma to to the point where a stable overbite the primary incisor resulting in lingual relationship exists.14 Relapse is usually displacement of the permanent tooth prevented by the normal overjet/overbite germ, supernumerary anterior teeth, an relationship that is achieved.15 Treatment over-retained pulpless modalities for correction of anterior deciduous tooth or root, odontomas, cross bite are tongue blades, reversed crowding stainless steel crowns, fixed acrylic in necrotic the or incisor region, inclined planes, bonded resin-composite 77 Suresh KS et al. slopes, removable acrylic appliances with finger springs, and Bruckl appliance.10,12,16 Teeth which erupt in cross bite may be corrected from the tipping forces that are provided by removable appliances but in cases of incisor root which are palatally displaced, removable appliance offering tipping force will not produce full correction. Fig 1: Pretreatment photograph showing rotated 21& retained 62. The aim of this case report was to canine bilaterally and class I molar describe fixed relation. The maxillary left central appliance in correction of severely incisor was mesiopalatally rotated and rotated anterior tooth and anterior dental maxillary cross bite with inadequate space for their palatally erupted was in cross bite alignment in mixed dentition patient. associated with retained primary lateral the advantages of left lateral incisor was incisor. (Fig-2) CASE REPORT An 11 year old male patient was Total space analysis revealed inadequate reported to Department of Pedodontics, space for the mesiodistal alignment of Government Dental College with the rotated central incisor as well as chief complaint of irregularly positioned palatally erupted lateral incisor, hence it upper front teeth. (Fig-1) The child’s was decided to extract upper left first Medical history was non contributory premolar to create space for alignment of and examination malpositioned teeth and also to provide revealed late mixed dentition in the sufficient space for the eruption of the upper arch with uneruped permanent permanent canine. 78 intraoral clinical Anterior tooth rotation & cross bite correction of the cross bite; hence lower bilateral removable bite plane was removed. The same nickel titanium wire was engaged with the rotated upper left central incisor. Patient was seen for routine orthodontic activation of the full arch appliance once in 15 days. After 3 months of activation, the rotated upper left central incisor was repositioned to its Fig 2: Dental casts showing rotated 21, normal position. (fig-3) palatally erupted 22 & retained 62. The parents were informed about the malocclusion, and a written consent to proceed with the treatment was taken and aimed at correction of the cross bite followed by rotation correction. In the first appointment, retained deciduous left lateral incisor was extracted and after the correction of cross bite, in subsequent appointment upper left first premolar was extracted. Two molar bands were cemented to the upper first molars and preadjusted edgewise brackets of 0.18 Fig 3: Dental casts showing derotated 21 slot were bonded on the respected teeth & correction of crossbite w.r.t 22. 15,14,11,21,22,24,25 and tooth in cross bite was engaged with 0.16 round nickel The titanium wire and bilateral removable retention was started by a modified posterior bite plane was placed in the Hawley lower arch to open the bite in the appliance removal, the childs intraoral anterior appearance was consistent with what one 79 region. There was rapid appliance retainer. was At removed the time and of Suresh KS et al. would normally find in a child of his between 8 to 11 years during which the age. root is being formed and the tooth is in the active stage of eruption. The important role plays not only the age of the child but also the motivation for treatment, how he or she perceives the problem. There are different treatment approaches Fig 4: Post treatment photograph showing well aligned teeth. for the correction of anterior dental cross bite which can be used in early mixed dentition period. These include tongue blade therapy18, reverse stainless steel DISCUSSION crowns19, removable Hawley retainer Several clinical treatments have been proposed in the literature for correcting malpositioned removable teeth and which fixed include appliances. Anterior cross bite is a condition which seldom corrects by itself because the maxillary incisor is locked behind the mandibular incisors and continues to progress leading to severe malocclusion, thus early treatment can reestablish proper muscle balance and a well balanced occlusal development. Early treatment is also directed towards preventing dysplastic growth of both skeletal and the dentoalveolar components.17 The ideal age for the correction of anterior dental cross bite is 80 with anterior Z-springs14 and bonded resin-composite slopes.16 The tongue blade therapy is successful only with patient cooperation, and there is no precise control of the amount and direction of force applied. The reverse stainless steel crowns have been shown to be successful but the two main disadvantages of using reverse stainless steel crowns are the unaesthetic appearance of the crown form and the limitations of working with an inclined slope that removable patient is already appliance cooperation formed. A also requires and parental supervision.5 The Lower Inclined Bite Plane is the traditional method used for Anterior tooth rotation & cross bite correcting or contour and may increase the chance of multiple tooth dental cross bite. It has to relapse. Hence decision was taken to be used only if there is enough space in choose fixed appliance as the right dental arch for labial movement of the approach in correction of malpositioned upper incisors. Clinically it can be used teeth in this case. A major goal of in cases when upper incisors are in cross extraction of maxillary left first premolar bite with more than one half of vertical in this patient was to make tooth mass overbite. The movement of teeth occurs compatible with the arch dimension, from the resulting force of closing thereby enhancing the stability of final muscle and inclined plane interaction. occlusion also the results of extraction One of the shortcomings of early therapy have been proven quite stable treatment is the possibility of a two- over the long term resulting in well phase orthodontic therapy as often it is alignment of the teeth with their difficult to estimate the further growth of adjacent. For a late mixed dentition child the anterior mandible.20 crowding in single The tooth presence mandibular of with severe rotation and crossbite were incisors, efficiently managed using fixed full arch tempromandibular joint problems, and maxillary considered deficiency before has to suggesting appliance. be this CONCLUSION appliance. Timely intervention of malocclusion One should be aware of limitations of should be initiated as early as possible to using removable appliances in correction prevent existing problems from getting of rotated tooth as one obtains point worse and minimize or eliminate the contact resulting in tipping movements need for comprehensive orthodontic which is less effective at derotation of treatment at a later stage. Treatment of tooth than fixed appliance. If the incisor malpositioned teeth are relatively precise root positioned palatally torquing the if it is planned with fixed orthodontic incisor root, with simple tipping force appliance will procline the tooth excessively postoperative results without any relapse leading to poor esthetics, poor gingival resulted in rapid correction of single 81 in attaining of desired Suresh KS et al. tooth dental cross bite & correction of 5. Skeggs RM, Sandler RM. Rapid severely rotated upper left central incisor correction of anterior crossbite with good alignment of the erupting using a fixed appliance. A case canine. report. Dent Update 2002; 29: 299-302. Hence it can conclude that in magnitude 6. Major PW, Glover K. Treatment of malpositioned teeth, fixed appliance of anterior cross-bites in the early by providing good anchorage, minimal mixed dentition. J Can Dent duration, should be considered as the Assoc 1992; 58: 574–575. treatment of choice. 7. Heikinheimo K, Myllarniemi S. evaluation REFERENCES of Salmi K, Long-term orthodontic diagnosis make at ages of 7 and 1. Malandris M, Mahoney EK. Aetiology, diagnosis & treatment of posterior crossbites in the primary dentition. International J Paediatr Dent 2004;14:155-156. 2. Huber KL, Suri L, Taneja P. Eruption disturbances of the maxillary incisors: a literature review. J Clin Pediatr Dent. 2008; 32: 221-230. 3. Bacetti T. associated 151–159. 8. Hannuksela A, Vaananen A. Predisposing malocclusion rotation aplasia of nonadjacent teeth. Angle Orthod 1998; 68: 471-474. factors in for 7-year-old children with special reference to atopic diseases. Am J Orthod Dentofacial Orthop 1987; 92: 299–303. 9. Hannuksela Tooth with 10 years. Eur J Orthod 1987; 9: A, Laurin A, Lehmus V, Kouri R. Treatment of cross-bite in the early mixed dentition. Proc Finn Dent Soc 1988; 84: 175–182. 4. Isaacson KG, Muir JJD, Reetd RT. Removable orthodontic appliances. 2nd edition Wrightlondon 2003: 30-34. 82 10. Olsen CB. Anterior crossbite correction in uncooperative or Anterior tooth rotation & cross bite disabled children. Case reports. deciduous Aust Dent J 1996; 41: 304–309. Orthod Dentofacial Orthop 1992; 11. Estreia F, Almerich J, Gascon F. Interceptive correction of dentition. J 102: 160–162. 18. Asher RS, Kuster CG, Erickson anterior crossbite. J Clin Pediatr L. Dent 1991; 15: 157–159. correction using a simple fixed 12. Valentine F, Howitt JW. Implications of early anterior crossbite correction. ASDC J Dent Child 1970; 37: 420–427. Anterior dental crossbite appliance: case report. Pediatr Dent 1986; 8: 53–55. 19. Croll TP, Lieberman WH. Bonded compomer slope for 13. Lee BD. Correction of crossbite. anterior tooth crossbite Dent Clin North Am 1978; 22: correction. Pediatr Dent 1999; 647-68. 21: 293–294. 14. Jacobs SG. Teeth in cross-bite: 20. Ngan P. Biomechanics maxillary Aust Dent J 1989; 34: 20–28. protraction in Class III patients. correction of anterior cross bite of the primary dentition. Am J expansion of the role of removable appliances. 15. Croll TP. Fixed inclined plane Orthod J 16. Bayrak S, Tunc ES. Treatment of anterior dental crossbite using bonded resin-composite slopes: case reports. Eur J Dent 2008; 2: 303–307. 17. Vadiakas G, Viazis AD. Anterior crossbite correction in the early CORRESPONDENCE Dr. Suresh KS Government Dental College & Research Institute, Bangalore – 560002 Email – [email protected] Phone - +919740159214 and Dentofacial Orthops 2002; 121: 582–583. Peodod 1984; 9: 84–94. 83 Am