Conservative approach to posttraumatic treatment of maxillary anterior teeth: A clinical report
Identifieur interne : 007D38 ( Istex/Corpus ); précédent : 007D37; suivant : 007D39Conservative approach to posttraumatic treatment of maxillary anterior teeth: A clinical report
Auteurs : Zvi Yoeli ; Nahum Samet ; Victor MillerSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1997.
English descriptors
- KwdEn :
- Canine, Central incisor, Clinical report, Cosmetic dentistry, Dent, Dentistry, First premolar, Further recession, Gingival, Incisor, Initial examination, Labial movement, Lateral, Lateral incisor, Masticatory system, Maxillary, Maxillary right, Midline, Mosby, Motor vehicle accident, Occlusal, Occlusal relationship, Open occlusal relationship, Periodont rest dent, Periodontal, Periodontal surgery, Periodontal therapy, Poor esthetics, Premolar, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Quintessence, Quintessence publishing, Restorative materials, Root surface, Samet, Selective occlusal, Sufficient space, Tapered root, Yoeli.
- Teeft :
- Canine, Central incisor, Clinical report, Cosmetic dentistry, Dent, Dentistry, First premolar, Further recession, Gingival, Incisor, Initial examination, Labial movement, Lateral, Lateral incisor, Masticatory system, Maxillary, Maxillary right, Midline, Mosby, Motor vehicle accident, Occlusal, Occlusal relationship, Open occlusal relationship, Periodont rest dent, Periodontal, Periodontal surgery, Periodontal therapy, Poor esthetics, Premolar, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Quintessence, Quintessence publishing, Restorative materials, Root surface, Samet, Selective occlusal, Sufficient space, Tapered root, Yoeli.
Url:
DOI: 10.1016/S0022-3913(97)70114-8
Links to Exploration step
ISTEX:FD4DE87A32492A8AD4561DB30FCF5EA50333E685Le document en format XML
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name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity><istex:entity SYSTEM="gr3" NDATA="IMAGE" name="gr3"></istex:entity><istex:entity SYSTEM="gr4" NDATA="IMAGE" name="gr4"></istex:entity><istex:entity SYSTEM="gr5" NDATA="IMAGE" name="gr5"></istex:entity><istex:entity SYSTEM="gr6" NDATA="IMAGE" name="gr6"></istex:entity><istex:entity SYSTEM="gr7" NDATA="IMAGE" name="gr7"></istex:entity><istex:entity SYSTEM="gr8" NDATA="IMAGE" name="gr8"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid><aid>82646</aid><ce:pii>S0022-3913(97)70114-8</ce:pii><ce:doi>10.1016/S0022-3913(97)70114-8</ce:doi><ce:copyright type="other" year="1997">Editorial Council of The Journal of Prosthetic Dentistry.</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para><ce:sup>a</ce:sup> Clinical Lecturer, Director of Removable Prosthodontics.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para><ce:sup>b</ce:sup> Instructor, Department of Prosthodontics.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para>J Prosthet Dent 1997;78:123-6.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★★</ce:label><ce:note-para><ce:italic>Reprint requests to:</ce:italic> <ce:small-caps>Dr. Zvi Yoeli Hebrew University Hadassah School of Dental Medicine PO Box</ce:small-caps> 12272 <ce:small-caps>Jerusalem</ce:small-caps> ISRAEL</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>♢</ce:label><ce:note-para>0022-3913/97/$5.00 + 0 <ce:bold>10/1/82646</ce:bold></ce:note-para></ce:article-footnote><ce:title>Conservative approach to posttraumatic treatment of maxillary anterior teeth: A clinical report</ce:title><ce:author-group><ce:author><ce:given-name>Zvi</ce:given-name><ce:surname>Yoeli</ce:surname><ce:degrees>DMD<ce:sup>a</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Nahum</ce:given-name><ce:surname>Samet</ce:surname><ce:degrees>DMD<ce:sup>b</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Victor</ce:given-name><ce:surname>Miller</ce:surname><ce:degrees>BChD<ce:sup>c</ce:sup></ce:degrees></ce:author><ce:affiliation><ce:textfn>Hebrew University, Hadassah School of Dental Medicine Jerusalem, Israel</ce:textfn></ce:affiliation></ce:author-group></head><body><ce:sections><ce:para>During the past few decades, esthetic and cosmetic dentistry have gained attention from dentists and patients alike. Facial harmony in proportion to the smile lip line, soft tissues, gingival line, and anatomic crown have been extensively discussed in the literature. <ce:cross-refs refid="bib1 bib2 bib3 bib4"><ce:sup>1-4</ce:sup></ce:cross-refs> Consequently, restorative materials and techniques have been advocated for masking, changing, repairing, or replacing tooth structure. <ce:cross-refs refid="bib4 bib5 bib6 bib7"><ce:sup>4-7</ce:sup></ce:cross-refs> However, an artistic skill of balancing reality with illusion is required to master the new techniques and restorative materials that are being introduced to dentistry.</ce:para><ce:para>This clinical report presents a comprehensive treatment plan for a 29-year-old woman with a posttraumatic anterior open occlusal relationship, crowding, and shifted midline with poor esthetics that resulted from a motor vehicle accident. Several treatment options were considered and presented to the patient during the 3 years after her accident. The patient rejected complicated alternatives <ce:cross-ref refid="bib8"><ce:sup>8</ce:sup></ce:cross-ref> and chose a relatively simple but comprehensive treatment option.</ce:para><ce:section><ce:section-title>CLINICAL REPORT</ce:section-title><ce:para>A 29-year-old woman sustained a blow to the face in a motor vehicle accident that had taken place 3 years previously. This accident resulted in lacerations on her chin and forehead and traumatization of maxillary incisors. The immediate treatment provided for the patient after the accident was (1) fixation of the maxillary anterior teeth for 20 days, (2) root canal treatments of the maxillary central incisors, and (3) adjunctive orthodontic treatment, for the anterior open occlusal relationship. Because of a lack of response to orthodontic forces, ankylosis of the maxillary anterior teeth was suspected.</ce:para><ce:para>The patient's chief complaint was poor esthetics when smiling, which revealed her open occlusal relationship, shifted midline, and the gingival recession around the maxillary left central incisor (<ce:cross-ref refid="fig1">Fig. 1</ce:cross-ref>) .
<ce:display><ce:figure id="fig1"><ce:label>Fig. 1</ce:label><ce:caption><ce:simple-para>Patient's occlusal relationship at initial appointment.</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display>Initial examination included intraoral and extraoral photographs, diagnostic casts mounted on a semiadjustable articulator, complete mouth radiographs, and periodontal assessment.</ce:para><ce:para>The clinical findings from the initial examination resulted in the diagnosis of an anterior open occlusal relationship between maxillary right and left first premolars, with obvious ankylosis the maxillary central incisors. The patient also exhibited maxillary anterior crowding, a 3 mm shift diagonally to the left of maxillary midline, irregular gingival contour, and several carious teeth. A comparison of the present records with those from 3 years before showed no essential changes.</ce:para><ce:para>A combined consultation by an oral surgeon, orthodontist, and prosthodontists provided alternative treatment options. Because the maxillary central incisors were ankylosed, orthodontic treatment alone would not be practical in view of the previous failed attempts. The prognosis for orthognathic surgery was poor for this patient because of root proximity in the anterior region, and the surgery would not provide a solution to the recession around the left central incisor. Therefore two alternative treatment plans were suggested for this patient.</ce:para><ce:para>Plan A included extraction of the maxillary central incisors, followed by restoration of the dentition with a fixed partial denture (FPD), extending from the maxillary right and left canine, which would allow realignment of the midline. With this treatment option, the anterior edentulous ridge would require augmentation to enhance the esthetics before proceeding to the final restoration. <ce:cross-ref refid="bib9"><ce:sup>9</ce:sup></ce:cross-ref></ce:para><ce:para>Plan B consisted of a combined therapy of restorative, including selective occlusal grinding, periodontal therapy, with minor adjunctive orthodontics for the maxillary left lateral incisor, canine, and first premolar without extraction of teeth.</ce:para><ce:para>Both treatment plans were presented to the patient with the aid of diagnostic wax-ups mounted on a semiadjustable articulator (H-2, Hanau-Teledyne, Buffalo, N.Y.). After presenting the advantages and disadvantages of all options to the patient, treatment plan B was selected by the patient.</ce:para></ce:section><ce:section><ce:section-title>TREATMENT</ce:section-title><ce:para>It has been demonstrated that moderate changes in occlusal vertical dimension are not detrimental to the masticatory system. <ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> Therefore selective occlusal grinding was performed to enhance initial closing of the anterior occlusal relationship by 2 mm ( <ce:cross-refs refid="fig1 fig2">Figs. 1 and 2</ce:cross-refs> ).
<ce:display><ce:figure id="fig2"><ce:label>Fig. 2</ce:label><ce:caption><ce:simple-para>Occlusal relationship after selective occlusal grinding.</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display><ce:cross-refs refid="bib11 bib12 bib13"><ce:sup>11-13</ce:sup></ce:cross-refs> This procedure improved the patient's appearance because she had a disproportionately elongated lower third of the face.</ce:para><ce:para>The maxillary left canine was forcefully erupted by reciprocally opposing the mandibular left canine and first premolar with the aid of lingual buttons and Selastics <ce:cross-ref refid="bib14"><ce:sup>14</ce:sup></ce:cross-ref> (Olympia, Dentaurum, Newtown, Pa.). This was expected to correct the remaining occlusal opening (<ce:cross-ref refid="fig3">Fig. 3</ce:cross-ref>) .
<ce:display><ce:figure id="fig3"><ce:label>Fig. 3</ce:label><ce:caption><ce:simple-para>Forced eruption using S-elastics.</ce:simple-para></ce:caption> <ce:link locator="gr3"></ce:link></ce:figure></ce:display>In the event orthodontic eruption failed, application of bonded hybrid composite material would be considered. <ce:cross-ref refid="bib6"><ce:sup>6</ce:sup></ce:cross-ref> At the same time, the maxillary left first premolar was reduced distally, at the expense of an existing silver amalgam restoration. This procedure allowed the maxillary left canine to be moved downward and distally while forcing the first premolar distally, into the space created. It appeared that the gingival contour around the maxillary left canine was altered by bringing the gingival unit coronally with the forced eruption procedure. <ce:cross-refs refid="bib15 bib16"><ce:sup>15,16</ce:sup></ce:cross-refs></ce:para><ce:para>Radiographic examination of the maxillary left lateral incisor favored orthodontic realignment of this tooth, because sufficient space for labial movement of the tapered root (<ce:cross-ref refid="fig4">Fig. 4</ce:cross-ref>) .
<ce:display><ce:figure id="fig4"><ce:label>Fig. 4</ce:label><ce:caption><ce:simple-para>Tapered root of maxillary left lateral incisor.</ce:simple-para></ce:caption> <ce:link locator="gr4"></ce:link></ce:figure></ce:display>Therefore the mesial enamel of the left canine was reduced, along with the distal surface of the left central incisor and the mesial and distal surfaces of the left lateral incisor. Recontouring of the proximal surfaces of these teeth developed sufficient space to align the teeth in that quadrant with orthodontic elastic ligature. Square wire 18 × 22 mm gauge and edgewise brackets (Dentaurum) were used to splint the ankylosed left central incisor and canine and to anchor the labial movement. Realignment of the teeth and shifting of the midline was performed by recontouring and bonding with microfilled composite (Silux Plus, 3M, Minneapolis, Minn.) (<ce:cross-ref refid="fig5">Fig. 5</ce:cross-ref>) .
<ce:display><ce:figure id="fig5"><ce:label>Fig. 5</ce:label><ce:caption><ce:simple-para>Final alignment of lateral incisor before removal of brackets.</ce:simple-para></ce:caption> <ce:link locator="gr5"></ce:link></ce:figure></ce:display></ce:para><ce:para>Two periodontal surgical procedures were performed, <ce:cross-ref refid="bib17"><ce:sup>17</ce:sup></ce:cross-ref> albeit without success to cover the root surface of the left central incisor (<ce:cross-ref refid="fig6">Fig. 6</ce:cross-ref>) .
<ce:display><ce:figure id="fig6"><ce:label>Fig. 6</ce:label><ce:caption><ce:simple-para>Although periodontal surgery has not masked root, thick band of attached gingiva has been formed.</ce:simple-para></ce:caption> <ce:link locator="gr6"></ce:link></ce:figure></ce:display>Coincidentally, an uncomplicated solution appeared on the market, the “gingival substitute” composite Ginga-Blend (Jeneric/Pentron, Wallingford, Conn.). This material was used to mask the large dehiscence of the root with the conventional class V restorative technique. <ce:cross-ref refid="bib4"><ce:sup>4</ce:sup></ce:cross-ref> This material restored the tooth appearance and enhanced the patient's smile ( <ce:cross-refs refid="fig7 fig8">Figs. 7 and 8</ce:cross-refs> ).
<ce:display><ce:figure id="fig7"><ce:label>Fig. 7</ce:label><ce:caption><ce:simple-para>Ginga-Blend composite was used to mask exposed root surface with pink resin.</ce:simple-para></ce:caption> <ce:link locator="gr7"></ce:link></ce:figure></ce:display><ce:display><ce:figure id="fig8"><ce:label>Fig. 8</ce:label><ce:caption><ce:simple-para>Final appearance of patient.</ce:simple-para></ce:caption> <ce:link locator="gr8"></ce:link></ce:figure></ce:display></ce:para></ce:section><ce:section><ce:section-title>DISCUSSION</ce:section-title><ce:para>It should be recalled that “the simplest treatment that will satisfy the needs of the patient is the best treatment,” <ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref> and less complex treatment is usually more predictable. This patient was young and it was important for her to save as many teeth as possible, both for psychological reasons and for future use in case of future failure. The option of extracting teeth and fabricating an FPD was considered too aggressive by the patient and was rejected by her. The durability of short-span FPD varies according to the literature. <ce:cross-refs refid="bib19 bib20"><ce:sup>19,20</ce:sup></ce:cross-refs> This treatment approach may be considered in the future if the incisors are lost. Therefore a less aggressive approach that was acceptable to the patient was chosen. Furthermore, treatment with restorative composite is more flexible because any needed repairs or replacements are uncomplicated and relatively inexpensive.</ce:para><ce:para>During the periodontal surgery, it became apparent that a significant part of the buccal plate of the left central incisor was missing. This anatomic defect might be the reason for the lack of success at masking the root surgically, and further recession should be expected in the future. In that case, Ginga-Blend will be used to mask it. However, it resulted in a thick gingival attachment that may be less prone to further recession, as compared with the thin gingiva of the patient before the periodontal surgeries <ce:cross-ref refid="bib17"><ce:sup>17</ce:sup></ce:cross-ref> ( <ce:cross-refs refid="fig5 fig6">Figs. 5 and 6</ce:cross-refs> ), and enhanced the masking effect of the root with Ginga-Blend composite ( <ce:cross-refs refid="fig7 fig8">Figs. 7 and 8</ce:cross-refs> ).</ce:para></ce:section><ce:section><ce:section-title>SUMMARY</ce:section-title><ce:para>This clinical report emphasizes that comprehensive treatment planning, whether simple or complex, requires interdisciplinary knowledge. Conservative treatment was implemented for this patient, a 29-year-old woman with a posttraumatic anterior open occlusal relationship, crowding, and a shifted midline. 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type="personal"><namePart type="given">Zvi</namePart><namePart type="family">Yoeli</namePart><namePart type="termsOfAddress">DMDa</namePart><affiliation>Hebrew University, Hadassah School of Dental Medicine Jerusalem, Israel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Nahum</namePart><namePart type="family">Samet</namePart><namePart type="termsOfAddress">DMDb</namePart><affiliation>Hebrew University, Hadassah School of Dental Medicine Jerusalem, Israel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Victor</namePart><namePart type="family">Miller</namePart><namePart type="termsOfAddress">BChDc</namePart><affiliation>Hebrew University, Hadassah School of Dental Medicine Jerusalem, Israel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><note>a Clinical Lecturer, Director of Removable Prosthodontics.</note><note>b Instructor, Department of Prosthodontics.</note><note>J Prosthet Dent 1997;78:123-6.</note><note>Reprint requests to: Dr. Zvi Yoeli Hebrew University Hadassah School of Dental Medicine PO Box 12272 Jerusalem ISRAEL</note><note>0022-3913/97/$5.00 + 0 10/1/82646</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo 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|texte= Conservative approach to posttraumatic treatment of maxillary anterior teeth: A clinical report
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