Traumatised Teeth

Traumatised, fractured, intruded or avulsed teeth may sometimes benefit from an orthodontic input. Teeth, which are fractured or intruded, may need extrusion, and this can be accomplished by using a number of different appliances and techniques. Figure 4 is an example of an upper appliance being used to extrude two unerupted upper incisors as an interceptive form of treatment. The upper permanent lateral incisors had already erupted; a clear sign that something was wrong. A supernumerary tooth, preventing the eruption of the central incisors, was first removed and brackets bonded to the central incisors. A modified palatal arch was then fitted and attached to the central incisor brackets with wire ligatures. The ligatures were gently activated to extrude the teeth. Once the teeth had erupted the remaining dentition was then allowed to develop prior to definitive orthodontic treatment. A similar technique can also be used to extrude fractured roots so that post-crowns can be placed on the teeth.

If upper incisors are traumatised and have a poor prognosis it is occasionally possible to transplant teeth to restore these sites. The main principles of transplantation have been well documented by Andreasen1 and provided these are followed, success rates in excess of 90% can be expected. Premolars are good teeth to replace upper central incisors because they often have the same width at the gingival margin as the teeth they are replacing. Figure 5 shows an

Fig. 3a Another case with missing upper lateral incisors

Fig. 3b Because the spaces were small these were closed up using a fixed appliance example of a case where the upper incisors had a poor prognosis and were extracted. The lower first premolars were then transplanted into the extraction sites. Veneers were then placed on the premolars to produce a satisfactory treatment outcome. The advantage of transplantation over implants is that transplantation can be undertaken at an early age and will grow as the patient grows. If an implant were placed at this stage it would, as the child grows, become gradually submerged. There is also a risk of ridge resorption by waiting until the patient is old enough to have an implant placed. In addition the cost of transplantation is also considerably less than for implants.

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