Orthodontic Treatment of Ankylosed Maxillary Incisor through Osteogenic Distraction and Simplified Biomechanics

Abstract

Ankylosed teeth may have a significant esthetic and functional impact especially at the anterior segment of the upper arch. Treatment of ankylosed teeth is challenging. The objective of this case report is to describe a clinical case in which an ankylosed tooth was treated with the use of osteogenic distraction associated with simplified orthodontic biomechanics. A 17-year-old female Caucasian patient presented with a Class II malocclusion, severe maxillary dental crowding, moderate mandibular dental crowding, anterior open bite, upper midline deviation to the right, and upper right central incisor in infraocclusion due to ankylosis. Treatment involved the use of the ankylosed tooth as anchorage for the distalization of the right upper segment to correct the Class II malocclusion and to create space prior to surgery. After one week of surgical osteotomy, traction of the tooth and bone segment was initiated with the use of intermaxillary elastics. The ankylosed tooth was moved to the desired position. Bone formation and mucogingival tissue adaptation were observed. Thus, esthetic and functional improvement was achieved. Osteogenic distraction associated with simplified orthodontic biomechanics is an alternative to the treatment of ankylosed teeth which can replace the use of distractor screws, making treatment simpler and more accessible.

Treatment of anterior open bite and an ankylosed incisor by applying multiloop edgewise archwire, mini-implants, and dentoalveolar distraction

“…15,18 A single-incisor dentoalveolar distraction was reported by Isaacson et al 19 and others. 1,3,7,9,13,16,[20][21][22][23][24][25][26]29 DO consists of 3 sequential periods: latency, distraction, and consolidation. The latency periods varied considerably for different case reports from 4 days to 2 weeks.…”

“…The single-tooth osteotomy block can be distracted by various methods, such as vertical extrusion bends, 4,5,7,19 vertical elastics, 21,22 a coil spring or loop, 5 a nickel-titanium wire, 5,7,15,16,19,[23][24][25] or a distraction device. 3,9,20,26 The advantages of using a distraction device are that the displacement of the dentoalveolar block gradually increases in precise amounts and that the patient can activate the distractor at home.…”

“…When growth is complete, there are several surgical treatment protocols to extrude an ankylosed tooth, such as single-tooth osteotomy, 4,13,14 surgical luxation, [15][16][17][18] corticotomy, 8 and distraction osteogenesis (DO). 1,3,7,9,13,16,[19][20][21][22][23][24][25][26] DO using distraction devices has become one of the most predictable treatment methods for ankylosed teeth. Kinzinger et al 27 applied a bone-borne distraction device which used adjacent alveolar bone as a source of anchorage.…”