Pacific Coast Society of Orthodontists Bulletin Summer 2017 - 45

Presentation Summary

will need to be planned. Transalveolar transplantation - repositioning of a tooth in the same
location - may also be considered. If the root
apex is formed, the tooth will require root canal
therapy.
It is difficult to predict root resorption, but there
are factors to be aware of while treatment is progressing. The average amount of root resorption
is 1.4 mm after maxillary anterior retraction, with
laterals affected more than central incisors.
Heavy forces will likely cause more resorption
than light forces. If an impacted canine is dilacerated, it may need extraction; guided eruption
may not be successful due to poor alignment and
possible root resorption.
Regional acceleratory phenomenon was briefly
discussed pertaining to the surgery first
approach in orthodontics. The first three to four
months show increased osteoclastic activity,
and tooth movement may be accelerated during
this time.9
In cases of impacted canines at the Y line of
Ennis, there is a high risk of ankylosis. An apicotomy may be performed, which is a root fracture
for surgical treatment of impacted maxillary
canines with dilacerations or apical root ankylosis. One hundred grams of force is used for extrusion, to be reactivated every two weeks.10
Accurate clinical diagnosis is possible only by
orthodontic force application. A single tooth
anterior open bite may be due to trauma; treatment started too early may result in relapse
due to non-growing alveolar bone in the area.
For growing patients, treatment may be resection
(with composite build-up), spontaneous reeruption, decoronation with eventual implant,

Summer 2017  PCSO Bulletin

or extraction and space closure. In adult patients,
treatment may be luxation, segmental
osteotomy with autogenous bone graft, or
distraction osteogenesis in cases with a severe
vertical bone defect. The distractor can be boneborne, tooth-borne, or may be created by a skeletal anchorage system. There is a latency period
of one week to encourage callous formation, followed by distraction at a rate of 0.5 to 1 mm/day
until the desired position is achieved, and finally,
consolidation for three months.11
Following traumatic injury to a primary incisor,
the direction of force is transmitted along the
long axis of the primary central incisor to the
labial side of the permanent central incisor,
which kills the Hertwig's epithelial root sheath
cells. Therefore, the labial side of the tooth no
longer produces dentin, but the palatal side
produces dentin at a normal rate. This causes
dilacerations, resulting in a cusp tip that heads
towards ANS. The patient must be informed of
the risk of root resorption; treatment consists
of a three-stage surgical protocol:
1.
2.
3.
4.
5.

Diagnosis
Opening of sufficient space
Closed exposure (surgery 1)
Traction
APF, when the tooth is closer to the level of
occlusion (surgery 2)
6. Traction
7. Labial root torque
8. Apicoectomy/root canal therapy as needed
(surgery 3)
In line with the guidance theory of eruption, an
impacted central will distally displace a lateral,
which will in turn displace the canine buccally.12

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

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