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Int J Dent Case Reports 2012; 2(1): 97-101 IJDCR 2012. All rights reserved
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CAS E REPORT
SPACE REGAINING WITH LIMITED ORTHODONTIC INTERVENTION-A CAS E REPORT
Roopa Abdullah1, Anisha Gupte
2, Alok Patel
3
1. Professor Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth Deemed University, dental
college and Hospital. Pune.
2. Post graduate student, Department of Pedodontics and Preventive Dentistry, Bharat i Vidyapeeth Deemed University,
dental college and Hospital. Pune.
3. Professor, Guide and H.O.D. Department of Pedodontics and Preventive Dentistry, Bharati Vidyapeeth Deemed
University, dental college and Hospital. Pune.
Address for correspondence
Gupte A
Bharati Vidyapeeth Dental College and Hospital, Katraj.
Pune 411046
Email: anisha.gupte@yahoo.com
ABSTRACT
Introduction: Early orthodontic intervention is often in itiated in the developing dentition to promote favorable
developmental changes. Interceptive orthodontics can eliminate or reduce the severity of a developing ma locclusion,
the complexity of o rthodontic treatment, overall treatment time and cost.
Case Report: A female ch ild aged 9 years reported to the department of Pedodontics and Preventive Dentistry, with
the chief complaint of malaligned lower right posterior teeth and difficulty in chewing. Clinical and rad iographic
examination revealed premature loss of the mandibular right second molar and subsequent drifting of the mandibular
right first premolar, resulting in severe space deficiency for lower right second premolar.
Discussion: Conventional space regaining methods could not be used in this case, thus space regaining was done by
limited orthodontic intervention.
Conclusion: This case shows the benefits of early orthodontic intervention and its importance in paediatric
dentistry today.
Abdullah, Gupte, Patel Space Regain ing With Limited Orthodontic Intervention
98 Int J Dent Case Reports Jan 2012, Vol.2, No. 1
INTRODUCTION
One of the main functions of the primary dentition is
the maintenance of the arch length, so that the
permanent dentition, which replaces it will have
sufficient space to erupt .No other factor plays a more
significant ro le in preventive and interceptive
dentistry than the preservation of deciduous dentition
till its normal time of exfoliation.(1)There are various
reasons for premature loss of deciduous teeth, like
deep dental caries, trauma or congenital absence,
which may present significant problems for the
growing child. (3)
Premature loss of a deciduous tooth or a group of
teeth may lead to a wide range of implications, one of
the most important being space loss as reported in the
early 20th
century by Stallard, Lyons, Willet and
others. (5) About 51% of the prematurely lost first
primary molars and 70% of the prematurely lost
second primary molars result in space loss and
consequent malposition of the permanent tooth in that
quadrant. (6)
Early orthodontic intervention done at this stage can
play a v ital ro le in either eliminating the developing
malocclusion or at least reducing the complexity of
the future orthodontic treatment.
CAS E REPORT
A female child aged 9 years reported to the
department of Pedodontics and Preventive Dentistry,
with the chief complaint of malaligned lower right
posterior teeth and difficulty in chewing.
She gave a past dental history of undergoing
extraction of her lower posterior tooth a year ago
along with multip le pulpectomies.
Clin ical examination showed presence of 12 teeth in
the maxilla (Fig 1), and 11 in the mandib le (Fig 2),
with class I molar relationship on the right and left
side.
Figure 1: Intraoral examination of maxilla.
The mandibular right posterior quadrant showed the
presence of a rotated first premolar, a distal drift ing
of the first premolar and canine, and mesial t ilt ing of
the first permanent molar leading to space closure,
thus obstructing the path of eruption of the second
premolar (Fig 2).
Figure 2: Intraoral examination of mandible
Radiographic examination revealed severe space loss
with the obstruction of the eruption pathway of the
second premolar (Fig 3).
Abdullah, Gupte, Patel Space Regain ing With Limited Orthodontic Intervention
99 Int J Dent Case Reports Jan 2012, Vol.2, No. 1
Figure 3: Preoperative Radiographic examination
Space analysis was done using study models (Fig 4).
Radiographic analysis revealed that the amount of
space available was 4mm and space required was
7.5mm. Thus, in this patient space regaining was
indicated on the mandibular right side (2).
Figure 4: Study model
Steps in treatment:
In the init ial appointment after completing the
occlusal assessment, oral prophylaxis and fluoride
application was done. The mandibular first
permanent molar on the right side was banded.This
was followed by bonding of the canine and first
premolar on the same side (Fig 5).
In the next appointment sectional 0.014 NiTi wire
was placed. The 0.014 Niti wire was selected for its
high flexib ility, to bring about initial alignment of the
arch along with derotation of the premolar (Fig 5).
Figure 5: Initial bonding using 0.014 NiTi
After a 3 week fo llow up it was seen that the init ial
alignment of the arch along with derotation of the
premolar was achieved.
Figure 6: Placement of open coil spring after initial
alignment
After this initial derotation the 0.014 NiTi wire was
then replaced by an 0.014 SS wire. At this stage the
canine of the contralateral side was also bonded for
additional anchorage and for maintaining the arch
form (Fig 6). Following this a NiTi open coil spring
was incorporated between the first premolar and the
permanent first molar for space regaining (Fig 7).
After a 3 week follow up, the space regained could be
visualized. At this stage a 3-3 power chain was
Abdullah, Gupte, Patel Space Regain ing With Limited Orthodontic Intervention
100 Int J Dent Case Reports Jan 2012, Vol.2, No. 1
incorporated to move the lower right canine mesially
and to consolidate the anterior spacing.
Figure 7: Placement of 3-3 power chain for additional
space regaining
After a 2 week fo llow up debonding was done
followed by placement of a band and loop space
maintainer (Fig 8).
Figure 8: Band and loop space maintainer cementation after
debonding
Radiographic examination at this stage showed the
amount of space regained, along with the
unobstructed path of eruption of the second premolar
(Fig 9).
DISCUSS ION
Early orthodontic intervention is often init iated in the
developing dentition to promote favorable
developmental changes. Interceptive orthodontics can
eliminate or reduce the severity of the developing
malocclusion, the complexity of orthodontic
treatment and overall treatment time and cost.
Figure 9: Radiograph showing amount of space regained
The premature loss of a deciduous tooth or teeth can
destroy the integrity of normal occlusion. The space
loss due to this premature loss of deciduous teeth,
especially deciduous molars, can lead to either mesial
migrat ion of the first permanent molar or d istal
drift ing of the anterior teeth leading to space closure.
This may cause either impaction or ectopic eruption
of the second premolar. (7)
FIG 10: Postoperative radiograph
Abdullah, Gupte, Patel Space Regain ing With Limited Orthodontic Intervention
101 Int J Dent Case Reports Jan 2012, Vol.2, No. 1
To correct this, various conventional space regainers
have been introduced over the years, like the Gerber
space regainer and the activated lingual arch (4). In
the present case, we could not use these conventional
space regainers because not only did we require
mesializat ion of the premolar but also the canine, and
the space required to be regained was more than 3mm
(4). A long with mesialization of the canine and
premolar, and d istalization o f the first permanent
molar, the derotation of the first premolar was also
required to be carried out. Thus, this case was
indicated for fixed orthodontic treatment with limited
intervention.
CONCLUS ION
This is one of the many cases showing the role of
interceptive orthodontics in Paediatric dentistry. It
displays a method of space regaining which may be
utilized for early intervention in the mixed dentition
period, where conventional space regainers cannot be
used. It also shows how early diagnosis and
intervention helps in eliminating the severity of a
developing malocclusion.
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