Wednesday, February 26, 2020

Iris Publishers-Open access Online Journal of Dentistry & Oral Health| Rotated Upper Central Incisor Complicated by Pathological Migration with Crowding in Upper and Lower Anterior Teeth Treated by Clear Aligners



Authored by Cecilia Young*


Background

Pathological tooth migration increased between 2.95 to 7.97 times as bone loss increased [1], it is difficult to treat, and the multidisciplinary approach is usually needed [2-4]. The combination of periodontal and orthodontic treatment is being used to improve the periodontal conditions and esthetics [2-6]. Most of the case reports were related to tipping or intrusion of the central incisors [2-6]. Fixed appliances make brushing and flossing more difficult. Oral hygiene practices during clear aligner treatment can be easily maintained. A Meta-analysis concluded that clear aligners were better for periodontal health than fixed appliances [7]. Another systematic review showed a significant improvement of the periodontal health indexes was revealed, in particular when clear aligner treatment was compared to fixed appliances [8], no periodontal adverse effects were observed in the studies using clear aligner treatment [8].
Yunyan et al concluded that clear aligners had advantage in segmented movement of teeth and shortened treatment duration in a systematic review [9], the eight relevant studies used Invisalign [9]. Rossini et al. stated that clear aligner treatment aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5mm; and it is not effective in controlling rotation, of rounded teeth in particular [10]. The devices applied in the 11 relevant studies were Invisalign [10].

Case Report

A 48-year-old lady with mobile rotated and overerupted upper right central incisor visited the dental clinic (Figure 1). She noticed that the tooth became longer and very mobile and wanted to improve the esthetics. She had no complaint with the profile (Figure 2). The upper and lower anterior teeth were crowded (Figure 3).


Diagnosis


It was difficult to estimate the original position of the tooth since the upper anterior teeth were crowded, whether it was pathologically migrated or the tooth was originally in an imbalance position that could not be controlled by the lip and finally over erupted and then started the periodontal problem, to help the discussion for the treatment goals, the operator requested the photos in her young age. The 11 was rotated but on the occlusal plane when she was 20 years old (figure 4). Pre-op OPG showed that there was generalised bone loss (figure 5). Pre-op tracing showed slightly retruded Maxilla and Mandible (Figure 6). 11 was rotated (figure 3) and overerupted (figure 3) with mobility.



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