Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 33

Case Report

How would you treat this malocclusion?
Post-Treatment
Case D.M. 24 years, 5 months

Treatment Plan
After reviewing the possible treatment options,
the patient expressed concerns about the cost
involved in future restorations, as well as maintenance, so he chose the first option to retrieve
both impacted teeth.
Treatment Progress
After discussing the treatment objectives and
options, the patient decided to recover the
impacted teeth. He was evaluated by his dentist
for dental and periodontal clearance to start
orthodontic treatment. Once he was cleared,
treatment was started by bonding the maxillary
arch only.
The patient was then sent for exposure of the
UL1 and UL3. As a back-up plan, the ULC was not
extracted, in case of ankylosis of the UL3 and
because of potential complications if the
impacted teeth did not erupt favorably.
After exposure of the teeth, the process of exerting forces on the impacted teeth was started. The
UL2 was not included in the initial setup and a
TMA spring was bent off of the upper left auxiliary slot to bring the UL3 buccally and away from
the UL2 root. To reduce taxing of the neighboring
teeth, a modified Nance appliance with an extension arm in the UL1 region was used.
In about seven months, periapical radiographs
and a small volume CBCT indicated that the UL3
had moved and that the ULC should be extracted
to allow the UL3 to come into the arch.
Less than two years into treatment, the UL1 was
in the arch and the UL3 crown was completely
exposed, but was still very apically positioned.
The UL2 was still not included in the treatment.
Some evidence of intrusion of the neighboring
teeth was evident. From this point until the end
of treatment, effort was focused on bringing the
UL3 into the arch and correcting the torque on

Summer 2017  PCSO Bulletin

the UL2 and UL3. At this point, the main archwire
was used to torque the UL3 root lingually bypassing the U2-2 to avoid taxing the anterior dentition. A sectional wire was used for the U2-2 and
the patient was radiographically and clinically
monitored for any signs of root resorption and
excessive mobility. Continuous archwires were
used in the maxillary arch after a period of
torquing the UL2 and UL3 with sectional wires.
Torquing of the UL2 and UL3 continued in the
continuous archwire. At this point, final X-rays
were taken to evaluate the teeth because they
would be more valuable at this point than at the
end of treatment after debonding. Considering
the proclination of the anterior teeth, a torquing
leash was used in addition to some IPR and
torquing of the maxillary and mandibular incisors.
In order to avoid unnecessary radiation, no X-rays
were taken after treatment. The only difference
can be physically seen in the final photos.
Treatment Results
The patient missed multiple appointments that
in total amounted to a loss of about 10 months
of active treatment. Although during treatment
there was concern about an anterior open bite, it
was well monitored and controlled. The patient
was finished in Class I occlusion with ideal overjet and overbite. He now has all permanent teeth
in function. While great care was taken to avoid
excessive force to the neighboring anterior teeth,
some evidence of mild root shortening is present
at the end. The patient has a bonded retainer on
the U3-3 and Essix-type retainers for both arches.
We assume that the anterior dentition have been
further uprighted; this could be confirmed if a
final X-ray were taken. However, since there was
no diagnostic value in taking another X-ray, we
accepted the X-ray taken a few months before
debonding as the final. Superimposition of the
initial and final tracings indicate mild bite opening, as well as uprighting and extrusion of the
anterior dentition.

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2017