unilateral canine distaliser / orthodontic courses by indian dental academy
TRANSCRIPT
A Simplified Distraction Device for Unilateral Canine Distalization
A Case Report
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INDIAN DENTAL ACADEMY
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• A 21 yr old male patient reported to the department.
• Chief Complaint – Malaligned teeth.
• Roth 018 prescription was used.
• Initial alingment and leveling was done and completion of Stage 1 achieved.
• During Stage 2, the left maxillary canine retracted completely but the right canine refused to shift from its original position.
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What happened???1. The canine bracket was inverted to minimize the
cortical anchorage.2. An anchorage device was placed to distalize the
canine, but in vain.3. The tooth was firm and gave a dull sound on
percussion.4. The patient was diagnosed to have an ankylosed
right maxillary canine.
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What’s this???
Root Resorption observed on the distopalatal aspect of the
ankylosed canine.www.indiandentalacademy.com
ANKYLOSIS…???• Ankylosis of teeth occurs due to anatomic fusion of
cementum or dentin with the alveolar bone. • The pathogenesis of ankylosis is unknown and may be
secondary to one of the many factors. Example - trauma, injury, chemical or thermal irritation, genetic influence
• In these circumstances orthodontic tooth movement is impossible and surgical repositioning of the ankylosed tooth is required.
Proffit WR, Am J Orthod 1981
Pelias MZ, Clin Genet 1985
Epker BN, Am J Orthod 1978
Medeiros PJ, AJODO 1997
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How did we work out this design?
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Presurgical Measures • Since orthodontic tooth movement was
considered impossible, a segmental osteotomy and gradual distal movement of the right maxillary canine was planned.
• Brackets on 15 & 13 were debonded and 16 was debanded prior to surgery.
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Surgical Measures• A segmental alveolar osteotomy was
performed in the upper right maxillary segment in close proximity to the periodontal space on the distal of 13 and the mesial of 15 to ensure complete retraction of the canine with no interposed bone in between.
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• After completing the osteotomy the segment was mobilized.
• This operative site was then sutured.
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Distraction Schedule• The first activation was
done 3 days post surgery.
• Screw was turned twice a day, creating 0.5 mm distal movement per day.
• Distraction continued for 15 days.
• Total amount of distal movement was 7 mm in the first premolar region.
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• After the canine was distalized completely, 13 & 15 were rebonded and 16 was rebanded.
• 17 x 25 NiTi wire was placed with continuous ligation from 13 to 16.
• After 7 days, we replaced the 17 x 25 NiTi archwire with 17 x 25 S.S. archwire with continuous ligation from 13 to 16.
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Outcome…
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There are two alternatives to consider for distraction:
• the use of horizontal elastics • the fixed screw type distractor
With the use of horizontal elastics, control of the distraction rate is difficult.
Possible complications of the segmental osteotomy are • Periodontal defects • Loss of vitality of teeth • Loss of blood supply (to both teeth and alveolar bone)
White RP, Surgical-orthodontic Treatment. St Louis: Mosby, 1991
Careful surgical procedure can avoid the complications with the adjacent teeth. Gradual distraction of the segment might be advantageous to
the blood supply of the mobilized segment.
Discussion
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Conclusion
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