18 Space Regaining With Limited Orthodontic Intervention a Case Report1

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: [email protected]

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).



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



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



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.

REFERENCES

1. Norman PM, Henery GE.Functional

maintenance of arch length. ASDC J Dent

Child 1984; 51:190-193.

2. R.D. Irwin, J.S. Hero ld & A. Richardson.

Mixed Dentition Analysis: A review of

methods and their accuracy. Int J Paediatr

Dent 1995; 5:137-142.

3. Chang JZ, Chen PH, Kuo SC. An appliance

to replace prematurely lost maxillary

anterior teeth using double stainless steel

crowns on abutment teeth. J Clin Pediatr

Dent 1999;23:285-288.

4. William R. Proffit, Henry W. Fields.

Textbook of Contemporary orthodontics, 3rd

ed. 2000.

5. Graber TM. Preventive orthodontics. In

Graber TM ed itor. Orthodontics principles

and practice, 3rd

ed Ph iladelphia: WB

Saunders company 2001p. 627-667.

6. Jeffry A. Managing the developing

occlusion. In: Mcdonald RE, Avery DR

editors. Dentistry for the child and

adolescent. 7th

ed. Philadelphia: Harcourt

India Private Limited; 2001:677-741.

7. Negi K S. Niti Bonded space

regainer/maintainer. J Indian Soc Pedod

Prevent Dent 2010; 2(3):113-115.

18 Space Regaining With Limited Orthodontic Intervention a Case Report1

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