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Surgical treatment of impactedincisors

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Age 8 years.Referred by GDP unerupted 11,12Irregular attender to GDPMH - NAD

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Supernumerary associatedwith 22

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Treatment Plan

Orthodontic Records General Anaesthetic surgical removal of

supernumerary.

Removal of upper right deciduous incisorsand gold chain exposure of upper right

lateral and central incisors. Patient must be seen 2 weeks post

operatively by orthodontist.

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Patient presentation 2 weeks post op.Upper right central gold chain visable, tooth high and unerupted.

Upper right lateral crown visable- gold chain attached

Insufficient anchorage available anteriorly to use a standard 2 x 4appliance therefore initial extrusion to use removable appliance

Visit 1

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Upper removable appliance used initially.

Patient cooperation essential with daily use of light elasticforces to extrude upper right lateral incisor.

Patient reviewed initially after 2 weeks of placement of URA

Visit 2: 2 weeks after treatment commenced

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Placement of 2 x 3 appliance with 0.016 NiTi .Long buccal spans must be protected ideally with SS buccal tubing

Visit 3 : 3 months from op

Vi i 4 5 h f i

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0.018 ss round wire with push coil to create space for upper central.

Wire ligation either side of push coil, patient requested colours too.Upper deciduous canines removed due to space requirements.

Visit 4 : 5 months from operation

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Sufficient space available , Twin wire procedure to extrude

upper central. Base wire 0.020 SS or 19 x 25 SS.

Sectional wire 0.016 Niti linked through gold chain.

Visit 6: 8 months after operation

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Continue with Twin wire until upper central near expectedocclusal level required

Visit 7: 9 months after operation

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Gold chain removed

Central incisor bracket

Placed and twin wirecontinues

Visit 8 : 11 months after op

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Next visit upper 0.018 x 0.025 niti wire placed.

Long buccal spans protected with buccal tubing

Visit 9:13 months

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Debond

Demineralisation evidentGingival margins altered due to

Reduced torque in upper right

Central incisor

Visit 10 : 15 months post op

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Visit 11

1 year post debond Upper fixed section retainer still in place.

Upper first premolars erupting.

Both maxillary canines buccally placed,there will be insufficient room for their

eruption. Jamie Lee will require further care at a later

date

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Summary This case took 14 months of active

orthodontic treatment.

Presents different ways of extruding teeth

which have been prevented from eruptingnaturally.

Confirms that any interceptive treatment is

likely to result in further treatment requiredat a later stage when the permanentdentition is established