This document describes a case study of using the Halterman technique to successfully treat an ectopically erupting permanent first molar within 2 months. The Halterman appliance consists of a band placed on the adjacent primary molar with a wire and distal hook, and an elastic chain placed between the hook and a button bonded to the permanent molar to apply a distal force. The case involved a 5-year-old girl whose left maxillary first permanent molar was ectopically erupting. A radiograph confirmed mesial eruption and resorption of the primary molar. The Halterman appliance was placed and corrected the impaction within 6 weeks, demonstrating the benefits of this technique over other traditional treatments for
hollow obturator in case of total maxillectomyDHANANJAYSHETH1
With the incorporation of neodymium magnets, the patient was able to insert and remove the 2-piece maxillary obturator prosthesis, engaging both the anterior and posterior undercuts without difficulty. This resulted in increased retention, stability, and improved speech and deglutition. At follow-up appointments, the patient expressed satisfaction with the prosthesis and gratitude that his chief complaints had been addressed.
This document describes a study on the socket shield technique for tooth replacement with dental implants. The socket shield technique involves retaining part of the facial root when extracting a tooth and immediately placing a dental implant. The study examined 15 patients treated with this technique between 2011-2018. Volumetric analysis using CT scans found that the socket shield technique helped maintain hard and soft tissue volumes compared to traditional immediate implant placement. The technique is described as an effective way to preserve alveolar bone and provide esthetic outcomes for dental implant treatment.
Rapid canine retraction and orthodontic treatment with dentoalveolar distract...Dr Mujtaba Ashraf
This document presents a study on a new technique called dentoalveolar distraction (DAD) to rapidly retract canines during orthodontic treatment. The study involved 10 patients where the maxillary first premolars were extracted and a distractor device was used to move the canines into the extraction sites at a rate of 0.8 mm per day. Full canine retraction was achieved in an average of 10 days with minimal anchorage loss. The canines tipped and translated distally on average 13 degrees. No complications were observed. The DAD technique reduces orthodontic treatment time by nearly 50% with no adverse effects on surrounding structures.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
Success rate of miniplate anchorage for bone anchored maxillary protractionSaba Basit
(1) The study evaluated the success rate of using Bollard miniplates for bone anchored maxillary protraction (BAMP) in growing children, finding a 97% success rate. (2) Failures occurred in the youngest patients and were addressed by removing and replacing miniplates under local anesthesia. (3) The high success rate was related to presurgical counseling, minimal invasive surgery, good postsurgical instructions, and orthodontic follow-up.
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.
hollow obturator in case of total maxillectomyDHANANJAYSHETH1
With the incorporation of neodymium magnets, the patient was able to insert and remove the 2-piece maxillary obturator prosthesis, engaging both the anterior and posterior undercuts without difficulty. This resulted in increased retention, stability, and improved speech and deglutition. At follow-up appointments, the patient expressed satisfaction with the prosthesis and gratitude that his chief complaints had been addressed.
This document describes a study on the socket shield technique for tooth replacement with dental implants. The socket shield technique involves retaining part of the facial root when extracting a tooth and immediately placing a dental implant. The study examined 15 patients treated with this technique between 2011-2018. Volumetric analysis using CT scans found that the socket shield technique helped maintain hard and soft tissue volumes compared to traditional immediate implant placement. The technique is described as an effective way to preserve alveolar bone and provide esthetic outcomes for dental implant treatment.
Rapid canine retraction and orthodontic treatment with dentoalveolar distract...Dr Mujtaba Ashraf
This document presents a study on a new technique called dentoalveolar distraction (DAD) to rapidly retract canines during orthodontic treatment. The study involved 10 patients where the maxillary first premolars were extracted and a distractor device was used to move the canines into the extraction sites at a rate of 0.8 mm per day. Full canine retraction was achieved in an average of 10 days with minimal anchorage loss. The canines tipped and translated distally on average 13 degrees. No complications were observed. The DAD technique reduces orthodontic treatment time by nearly 50% with no adverse effects on surrounding structures.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
Success rate of miniplate anchorage for bone anchored maxillary protractionSaba Basit
(1) The study evaluated the success rate of using Bollard miniplates for bone anchored maxillary protraction (BAMP) in growing children, finding a 97% success rate. (2) Failures occurred in the youngest patients and were addressed by removing and replacing miniplates under local anesthesia. (3) The high success rate was related to presurgical counseling, minimal invasive surgery, good postsurgical instructions, and orthodontic follow-up.
Surgery of Labially Impacted Canine & Orthodontic Management – A Case ReportAbu-Hussein Muhamad
Maxillary canines are one of the most common teeth that are impacted among patients seeking orthodontic treatment. Depending on the position of these impacted teeth, various surgical techniques have been employed for their exposure. His primary goal of surgical phase is to provide the means for correct position of orthodontic anchorage. Additionally, the technique used must ensure favorable tissue anatomy that will permit long-term maintenance of periodontal health. In the present case, a labially impacted maxillary left canine was surgically exposed using an apically positioned flap. Orthodontic extrusion was carried out further.
immediate vs delayed implant placement in anterior single tooth extraction.rakhi chaudhry
This study compared immediate versus delayed dental implant placement in 124 patients requiring single tooth extractions. Immediate implants placed at the time of extraction required bone augmentation more often than implants placed 12 weeks later (72% vs 43.9%). Delayed implants were less likely to have wound failures and exhibited better soft tissue outcomes. Based on the need for more frequent bone grafting and poorer aesthetic results, the study concludes delayed implant placement may be preferable to immediate placement in the aesthetic zone.
Immediate implant placement following tooth extraction a case reportAbu-Hussein Muhamad
Immediate dental implants are an attractive option to patients and dentists. This paper report the management of a
fractured right permanent maxillary central incisor with extraction of the root followed by immediate implant placement
with two years follow-up.
“Horizontal Ridge Augmentation- Worth or Vain?”- Guest lecture as a part of “Perio Interactions- Edition IX” conducted by Saveetha Dental College and Hospitals, Chennai on 20/12/2017.
Surgically assisted rapid maxillary expansion (SARME) is a surgical technique used to widen the maxilla. It involves performing corticotomies through the zygomatic buttress and releasing other resistant structures like the midpalatal suture and pterygoid plates. An expander is placed preoperatively and activated starting 5 days post-op at 0.5mm/day. SARME allows for greater expansion than orthodontics alone and has better stability than segmental osteotomies. It is used to treat transverse deficiencies over 5mm and failed orthodontic expansion in adults. Risks include periodontal damage, root damage, and nasal complications.
socket shield technique is a modified method of implant placement where many short comings of implant placement can be solved...
it is nothing but retaining of buccal cortical plate during extraction and implant is placed immediatly
The document discusses the socket shield technique, which involves leaving part of the root when extracting a tooth to preserve the alveolar bone. It aims to prevent resorption, especially on the buccal side. The retained root fragment acts as a shield. A study of 20 patients found significantly less horizontal and vertical bone loss using this technique compared to conventional extraction and implantation. The socket shield technique was shown to effectively preserve buccal bone and improve implant stability over time. Various classifications of socket shield types are proposed based on the clinical scenario and the goal of maintaining tissue and achieving good esthetics for immediate implantation.
The effect of vibration on the rate of leveling and alignmentEdwardHAngle
This study evaluated the effects of vibration therapy using an AcceleDent device on the rate of orthodontic leveling and alignment in the mandibular arch. The study found that patients who used the AcceleDent device for 20 minutes per day experienced faster leveling and alignment times compared to control groups. For leveling, the AcceleDent group achieved the desired outcome in an average of 160 days, which was 48 and 55 days faster than the study and pre-study control groups respectively. For alignment, the AcceleDent group achieved the desired outcome in an average of 93 days, which was 27 and 38 days faster than the study and pre-study control groups, though the differences for alignment were not
Journal club on Surgical treatment of periiMplantitis using a bone substitute...Shilpa Shiv
This study evaluated the 5-year outcomes of surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane. 38 patients with peri-implantitis were treated with either a bone substitute alone or with a membrane. At 5 years, clinical improvements from treatment were maintained, including reduced bleeding and probing depths. Radiographic bone fill increased by 1.1-1.3 mm with no significant difference between treatment groups. Strict post-surgical plaque control was important for successful treatment outcomes. The membrane did not provide additional benefit to bone fill.
“Program on Ridge Split and Ridge Augmentation for Implant Placement”- Two lectures on “Concepts of Ridge Augmentation” and “Novel and Simpler Approaches to Ridge Augmentation”. Event organized by the Dental Experts and held at Paneenya Mahavidyalaya Institute of Dental Sciences, Hyderabad, India on 18/11/2016.
complete denture after a stroke ( Prosthodontics)DHANANJAYSHETH1
This document summarizes a journal club presentation about using orofacial myofunctional therapy and a modified denture to improve oral function for an edentulous patient after a stroke. Key points:
- A 70-year-old man had difficulty with tongue movement, mastication after a stroke 2 years prior
- A denture was fabricated with a wire and pearl in the palate to guide the mandible and encourage tongue exercises
- After 3 months of exercises and wearing the denture, the patient's tongue movement, mastication, and swallowing improved and the effects were maintained.
Article teixeira effects of micro-osteoperforationCentric Learning
1. The study examined the effect of micro-osteoperforations (MOPs) on the rate of tooth movement in 20 patients undergoing orthodontic treatment.
2. The experimental group received MOPs on one side of the maxilla prior to canine retraction, while the control group did not receive MOPs.
3. MOPs significantly increased the rate of tooth movement by 2.3-fold and increased inflammatory marker levels. Patients did not report significant pain from the procedure.
HEMISECTION: A CONSERVATIVE APPROACH FOR FURCATION-INVOLVED MANDIBULAR MOLARAbu-Hussein Muhamad
This document describes a case study of a hemisection procedure performed on a mandibular first molar. A 26 year old male patient presented with pain and caries in his left mandibular first molar. Radiographs and probing revealed furcation involvement and severe bone loss around the mesial root. It was decided to perform a hemisection to remove just the mesial root and crown portion while preserving the distal root. After endodontic treatment of the distal root, the mesial root and crown were surgically removed. The patient was followed up after restoration of the distal root with a full crown, and had good oral function and no further issues. The document discusses the indications, technique, and long
There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.
A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.
Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal
The document summarizes various techniques for bone regeneration after tooth extractions, including open socket, closed flap, and ridge preservation techniques. Studies comparing outcomes of using membranes like Goretex and Resolut to promote bone growth are described. One study found that Goretex membranes led to less bone width and height loss compared to control sockets when there was no membrane exposure. Another randomized study showed that using BMP-2 in collagen sponges led to greater bone width gains compared to placebo or no treatment.
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS on ANDREW'S BRIDGE SYSTEMNAMITHA ANAND
This document summarizes a journal club presentation about the Andrews Bridge System. Key points include:
- The Andrews Bridge System is a fixed-removable partial denture that combines fixed retainers connected by a bar with removable pontics for esthetic rehabilitation of edentulous ridges.
- Advantages include improved esthetics, hygiene, phonetics and stress distribution compared to removable partial dentures.
- A clinical case report describes using the system to restore a patient missing maxillary and mandibular anterior teeth following trauma. Post-treatment, the patient had pleasing esthetics and function.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
This presentation is a review of MANDIBULAR MOLAR ROOT RESECTION VERSUS IMPLANT THERAPY A RETROSPECTIVE NONRANDOMIZED STUDYZ
afiropoulos GG, Hoffmann O, Kasaj A, Willershausen B, Deli G, Tatakis DN.Journal of Oral Implantology, 2009
Management of a patient with temporomandibular disorder and trauma from occlu...IJARIIT
The occlusal disharmony has been proven to cause Temporomandibular Disorder (TMD) but not for every patient with occlusal
interference. Elimination of occlusal interference and subsequent stabilizing of occlusion is the most important aspect of treating
temporomandibular disorder1.The concept of Temporomandibular Disorder (TMD) usually includes a wide variety of signs and
symptoms such as pain from the jaw muscles or on mandibular movement, clicking sound, locking/luxation of joints as well as
restricted mandibular movement. Often, TMD has been evaluated on the basis of variation in rather insignificant signs and
symptoms, for instance, variation in muscle sites that are tender to palpation, without correlation to experienced problems. The
etiology of TMD is usually considered multifactorial. Untreated malocclusion, unstable occlusion, stress, psychologic factors,
trauma, individual predisposition and structural conditions have been suggested as possible etiologic factors.
Minimally Invasive Extraction and Immediate Implant Placement with Single-Sta...Abu-Hussein Muhamad
This case report describes the immediate placement of a dental implant into the socket of an extracted fractured maxillary lateral incisor tooth. The tooth was extracted atraumatically without flap reflection to preserve the alveolar bone. A dental implant was immediately placed into the prepared socket and temporized with a bonded restoration. At follow-ups 12 months after loading, the patient exhibited no clinical or radiographic complications and good osseointegration of the implant. Immediate implant placement and provisionalization can provide esthetic, functional and tissue preservation benefits compared to delayed placement after extraction socket healing.
Zygomatic anchorage ( mini plates ) in orthodontic bilal falahi
1. The document discusses using zygomatic miniplates as anchorage for orthodontic tooth movement, such as intrusion and retraction.
2. Miniplates are surgically placed on the zygomatic bones and used to apply orthodontic forces from elastic threads or coils.
3. Several case reports describe using this technique to correct anterior open bites, close spaces, and intrude supererupted molars.
This document discusses impacted teeth, focusing on impacted canines. It notes that impacted canines can cause resorption of adjacent teeth if not diagnosed early. Interceptive measures like extracting deciduous canines can help correct some palatal impactions. Treatment of impacted canines is lengthy and involves exposing the tooth to attach a bracket or chain for traction into the dental arch. Referral should occur early if there is suspicion of an impacted tooth to minimize required treatment.
Treatment concept by Watted for a controlled alignment of palatally impacted ...Abu-Hussein Muhamad
It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be
buccal or palatal. The treatment focuses mainly on the exposure and on the orthodontic realignment of the impacted
tooth. There are situations when canines erupt spontaneously after their surgical discovery. The present paper has the
purpose of approaching aspects related to impacted upper permanent canines by a literature review, including
localization and treatment conducts.
Key words: Impacted canine, periodontal, surgical-orthodontic treatment.
immediate vs delayed implant placement in anterior single tooth extraction.rakhi chaudhry
This study compared immediate versus delayed dental implant placement in 124 patients requiring single tooth extractions. Immediate implants placed at the time of extraction required bone augmentation more often than implants placed 12 weeks later (72% vs 43.9%). Delayed implants were less likely to have wound failures and exhibited better soft tissue outcomes. Based on the need for more frequent bone grafting and poorer aesthetic results, the study concludes delayed implant placement may be preferable to immediate placement in the aesthetic zone.
Immediate implant placement following tooth extraction a case reportAbu-Hussein Muhamad
Immediate dental implants are an attractive option to patients and dentists. This paper report the management of a
fractured right permanent maxillary central incisor with extraction of the root followed by immediate implant placement
with two years follow-up.
“Horizontal Ridge Augmentation- Worth or Vain?”- Guest lecture as a part of “Perio Interactions- Edition IX” conducted by Saveetha Dental College and Hospitals, Chennai on 20/12/2017.
Surgically assisted rapid maxillary expansion (SARME) is a surgical technique used to widen the maxilla. It involves performing corticotomies through the zygomatic buttress and releasing other resistant structures like the midpalatal suture and pterygoid plates. An expander is placed preoperatively and activated starting 5 days post-op at 0.5mm/day. SARME allows for greater expansion than orthodontics alone and has better stability than segmental osteotomies. It is used to treat transverse deficiencies over 5mm and failed orthodontic expansion in adults. Risks include periodontal damage, root damage, and nasal complications.
socket shield technique is a modified method of implant placement where many short comings of implant placement can be solved...
it is nothing but retaining of buccal cortical plate during extraction and implant is placed immediatly
The document discusses the socket shield technique, which involves leaving part of the root when extracting a tooth to preserve the alveolar bone. It aims to prevent resorption, especially on the buccal side. The retained root fragment acts as a shield. A study of 20 patients found significantly less horizontal and vertical bone loss using this technique compared to conventional extraction and implantation. The socket shield technique was shown to effectively preserve buccal bone and improve implant stability over time. Various classifications of socket shield types are proposed based on the clinical scenario and the goal of maintaining tissue and achieving good esthetics for immediate implantation.
The effect of vibration on the rate of leveling and alignmentEdwardHAngle
This study evaluated the effects of vibration therapy using an AcceleDent device on the rate of orthodontic leveling and alignment in the mandibular arch. The study found that patients who used the AcceleDent device for 20 minutes per day experienced faster leveling and alignment times compared to control groups. For leveling, the AcceleDent group achieved the desired outcome in an average of 160 days, which was 48 and 55 days faster than the study and pre-study control groups respectively. For alignment, the AcceleDent group achieved the desired outcome in an average of 93 days, which was 27 and 38 days faster than the study and pre-study control groups, though the differences for alignment were not
Journal club on Surgical treatment of periiMplantitis using a bone substitute...Shilpa Shiv
This study evaluated the 5-year outcomes of surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane. 38 patients with peri-implantitis were treated with either a bone substitute alone or with a membrane. At 5 years, clinical improvements from treatment were maintained, including reduced bleeding and probing depths. Radiographic bone fill increased by 1.1-1.3 mm with no significant difference between treatment groups. Strict post-surgical plaque control was important for successful treatment outcomes. The membrane did not provide additional benefit to bone fill.
“Program on Ridge Split and Ridge Augmentation for Implant Placement”- Two lectures on “Concepts of Ridge Augmentation” and “Novel and Simpler Approaches to Ridge Augmentation”. Event organized by the Dental Experts and held at Paneenya Mahavidyalaya Institute of Dental Sciences, Hyderabad, India on 18/11/2016.
complete denture after a stroke ( Prosthodontics)DHANANJAYSHETH1
This document summarizes a journal club presentation about using orofacial myofunctional therapy and a modified denture to improve oral function for an edentulous patient after a stroke. Key points:
- A 70-year-old man had difficulty with tongue movement, mastication after a stroke 2 years prior
- A denture was fabricated with a wire and pearl in the palate to guide the mandible and encourage tongue exercises
- After 3 months of exercises and wearing the denture, the patient's tongue movement, mastication, and swallowing improved and the effects were maintained.
Article teixeira effects of micro-osteoperforationCentric Learning
1. The study examined the effect of micro-osteoperforations (MOPs) on the rate of tooth movement in 20 patients undergoing orthodontic treatment.
2. The experimental group received MOPs on one side of the maxilla prior to canine retraction, while the control group did not receive MOPs.
3. MOPs significantly increased the rate of tooth movement by 2.3-fold and increased inflammatory marker levels. Patients did not report significant pain from the procedure.
HEMISECTION: A CONSERVATIVE APPROACH FOR FURCATION-INVOLVED MANDIBULAR MOLARAbu-Hussein Muhamad
This document describes a case study of a hemisection procedure performed on a mandibular first molar. A 26 year old male patient presented with pain and caries in his left mandibular first molar. Radiographs and probing revealed furcation involvement and severe bone loss around the mesial root. It was decided to perform a hemisection to remove just the mesial root and crown portion while preserving the distal root. After endodontic treatment of the distal root, the mesial root and crown were surgically removed. The patient was followed up after restoration of the distal root with a full crown, and had good oral function and no further issues. The document discusses the indications, technique, and long
There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.
A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.
Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal
The document summarizes various techniques for bone regeneration after tooth extractions, including open socket, closed flap, and ridge preservation techniques. Studies comparing outcomes of using membranes like Goretex and Resolut to promote bone growth are described. One study found that Goretex membranes led to less bone width and height loss compared to control sockets when there was no membrane exposure. Another randomized study showed that using BMP-2 in collagen sponges led to greater bone width gains compared to placebo or no treatment.
JOURNAL CLUB PRESENTATION IN PROSTHODONTICS on ANDREW'S BRIDGE SYSTEMNAMITHA ANAND
This document summarizes a journal club presentation about the Andrews Bridge System. Key points include:
- The Andrews Bridge System is a fixed-removable partial denture that combines fixed retainers connected by a bar with removable pontics for esthetic rehabilitation of edentulous ridges.
- Advantages include improved esthetics, hygiene, phonetics and stress distribution compared to removable partial dentures.
- A clinical case report describes using the system to restore a patient missing maxillary and mandibular anterior teeth following trauma. Post-treatment, the patient had pleasing esthetics and function.
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoec...Shilpa Shiv
Journal Club On Subepithelial Connective Tissue GraftAssociated with Apicoectomy andRoot-End Fillings in the Treatment ofDeep Localized Gingival Recession withApex Root Exposure
This presentation is a review of MANDIBULAR MOLAR ROOT RESECTION VERSUS IMPLANT THERAPY A RETROSPECTIVE NONRANDOMIZED STUDYZ
afiropoulos GG, Hoffmann O, Kasaj A, Willershausen B, Deli G, Tatakis DN.Journal of Oral Implantology, 2009
Management of a patient with temporomandibular disorder and trauma from occlu...IJARIIT
The occlusal disharmony has been proven to cause Temporomandibular Disorder (TMD) but not for every patient with occlusal
interference. Elimination of occlusal interference and subsequent stabilizing of occlusion is the most important aspect of treating
temporomandibular disorder1.The concept of Temporomandibular Disorder (TMD) usually includes a wide variety of signs and
symptoms such as pain from the jaw muscles or on mandibular movement, clicking sound, locking/luxation of joints as well as
restricted mandibular movement. Often, TMD has been evaluated on the basis of variation in rather insignificant signs and
symptoms, for instance, variation in muscle sites that are tender to palpation, without correlation to experienced problems. The
etiology of TMD is usually considered multifactorial. Untreated malocclusion, unstable occlusion, stress, psychologic factors,
trauma, individual predisposition and structural conditions have been suggested as possible etiologic factors.
Minimally Invasive Extraction and Immediate Implant Placement with Single-Sta...Abu-Hussein Muhamad
This case report describes the immediate placement of a dental implant into the socket of an extracted fractured maxillary lateral incisor tooth. The tooth was extracted atraumatically without flap reflection to preserve the alveolar bone. A dental implant was immediately placed into the prepared socket and temporized with a bonded restoration. At follow-ups 12 months after loading, the patient exhibited no clinical or radiographic complications and good osseointegration of the implant. Immediate implant placement and provisionalization can provide esthetic, functional and tissue preservation benefits compared to delayed placement after extraction socket healing.
Zygomatic anchorage ( mini plates ) in orthodontic bilal falahi
1. The document discusses using zygomatic miniplates as anchorage for orthodontic tooth movement, such as intrusion and retraction.
2. Miniplates are surgically placed on the zygomatic bones and used to apply orthodontic forces from elastic threads or coils.
3. Several case reports describe using this technique to correct anterior open bites, close spaces, and intrude supererupted molars.
This document discusses impacted teeth, focusing on impacted canines. It notes that impacted canines can cause resorption of adjacent teeth if not diagnosed early. Interceptive measures like extracting deciduous canines can help correct some palatal impactions. Treatment of impacted canines is lengthy and involves exposing the tooth to attach a bracket or chain for traction into the dental arch. Referral should occur early if there is suspicion of an impacted tooth to minimize required treatment.
Treatment concept by Watted for a controlled alignment of palatally impacted ...Abu-Hussein Muhamad
It is known that maxillary canines remain impacted more often than the mandibular canines, and the inclusion can be
buccal or palatal. The treatment focuses mainly on the exposure and on the orthodontic realignment of the impacted
tooth. There are situations when canines erupt spontaneously after their surgical discovery. The present paper has the
purpose of approaching aspects related to impacted upper permanent canines by a literature review, including
localization and treatment conducts.
Key words: Impacted canine, periodontal, surgical-orthodontic treatment.
This document summarizes key points about early treatment of tooth eruption disturbances from a presentation by Dr. Juri Kurol. It discusses that early treatment is purportedly easier and less expensive but should not be prescribed automatically without evaluating need and prognosis. Early treatment is recommended to avoid further disturbances during eruption and prevent complications like tooth resorption. Common disturbances requiring early treatment include ectopic maxillary first molars, mesiodens, ankylosed deciduous molars, and palatally erupting canines to prevent root resorption of incisors. Early extraction of palatally erupting canines in ages 10-13 normalized 78% of cases. More evidence is needed to demonstrate benefits of early treatment versus
Aim: Dental impaction is a very frequent problem and the canine tooth is one of the most affected. Impacted canines result
in many complications and their early diagnosis by radiographic evaluation is imperative. The aim of the present study was
to determine the prevalence of impacted canines in the Arab population in Israel(48Arabs). Materials and Methods: The
panoramic radiographic records of 2200patients attending the Center for Dentistry Research and Aesthetics, Jatt/Israel ,
between June 2006 and December 2013 were examined for the study. The age of the patients ranged from 10.5 to
39,5years, with a mean of 16,2years. Results: The prevalence of canine impaction in males was 1,6% and 2,1% in
females.in maxillary,and 0,6%mandibular The overall prevalence was 4,3 %. Maxillary left canines were the most
frequently impacted Only 13 cases showed impaction of the mandibular canine. Unilateral impaction was seen in 0,5% of
the patients. Conclusion: Canines play a vital role in facial appearance, dental esthetics, arch development, and functional
occlusion. If signs of ectopic eruption are detected early, every effort should be made to prevent impaction and its
consequences. Early intervention eliminates the need for surgical intervention and complex treatment.
This document discusses impacted and unerupted maxillary incisors. It provides information on prevalence, causes such as supernumerary teeth or odontomes, and classifications of delayed eruption. For management, it recommends examining patient history, radiographs, and surgical exposure techniques. Surgical exposure can be open, involve an apically repositioned flap, or use a closed eruption procedure. Factors like position, angulation, and amount of attached gingiva determine the best exposure technique. Orthodontic treatment may involve space creation, surgical exposure with orthodontic alignment, or tooth removal and space management. Complications of orthodontic treatment include relapse, non-compliance, root resorption,
The mandibular second premolar is one of the most frequently impacted teeth. The recommended treatment is to extract the second primary molar with or without removing the bone along the eruption path, to uncover the tooth surgically and move it into the arch by orthodontic treatment.
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
Tooth eruption involves the migration of the teeth from a nonfunctional position within the bone to a functional position in the jaw. In orthodontic practice, it is inevitable that one will encounter eruptive abnormalities such as impacted, ectopically erupting, transposed, congenitally missing, and supernumerary teeth..
Tooth eruption involves the migration of the teeth from a nonfunctional position within the bone to a functional position in the jaw. In orthodontic practice, it is inevitable that one will encounter eruptive abnormalities such as impacted, ectopically erupting, transposed, congenitally missing, and supernumerary teeth..
Tooth eruption involves the migration of the teeth from a nonfunctional position within the bone to a functional position in the jaw. In orthodontic practice, it is inevitable that one will encounter eruptive abnormalities such as impacted, ectopically erupting, transposed, congenitally missing, and supernumerary teeth..
This document describes the case of a 16-year-old girl with an impacted mandibular second premolar. The tooth was impacted horizontally near the lingual sulcus and covered by gingiva. Orthodontic treatment using aligners and open coil springs created space. The impacted tooth was then surgically exposed using a closed exposure technique and attached to the archwire using a button and chain. Over months of orthodontic forces, the tooth was moved into position in the dental arch. The document reviews principles of managing impacted second premolars and concludes that with adequate treatment, even severely impacted teeth can erupt into functional occlusion.
The purpose of this article is to review the principles of case management of soft tissue impacted second premolars mandibular and to illustrate their potential to respond well to the treatment. Although the scope of treatment may depend on a varying range of factors, this case report demonstrates the inherent potential for good treatment outcome in cases of soft tissue impactions
Eruptive anomalies are present in many routine orthodontic cases. The challenge in them is to diagnose them correctly
and manage them in a way so as to maintain the esthetic and functional harmony of the stomatognathic system [1]. The orthodontist must know how to correct these anomalies rather than extracting the malposed tooth as this would lead to poor occlusion and
loss of masticatory function [2]. This article presents an overview
on various anomalies seen due to impaction in daily orthodontic
practice along with step by step management of each
This document discusses impactions in orthodontics. It begins by defining an impaction as a tooth that fails to fully erupt due to being blocked by bone or other teeth. Causes of impactions include genetic factors, infections, cysts, tumors and lack of space. Diagnosis involves clinical exams, periapical x-rays, panoramic x-rays and CT scans to determine the tooth's position. Treatment options include extracting the impacted tooth, exposing it surgically and applying orthodontic forces to guide its eruption, or leaving it undisturbed if it is not causing issues. Specific techniques for managing different types of impactions are covered such as canine impactions and impacted premolars and mol
Eruptive anomalies are present in many routine orthodontic cases. The challenge in them is to diagnose them correctly
and manage them in a way so as to maintain the esthetic and functional harmony of the stomatognathic system [1]. The orthodontist must know how to correct these anomalies rather than extracting the malposed tooth as this would lead to poor occlusion and
loss of masticatory function [2]. This article presents an overview
on various anomalies seen due to impaction in daily orthodontic
practice along with step by step management of each.
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines treated with surgical exposure and orthodontic treatment
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines treated with surgical exposure and orthodontic treatment.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
The document discusses class II division 1 malocclusion, including its features such as a protrusive maxilla and retrusive mandible. Early intervention for growing maxillary excess includes using a Kloehn facebow headgear to restrain maxillary growth and distalize the upper dentition into a class I relationship. The headgear is effective in correcting maxillary protrusion while allowing normal mandibular growth.
- Class II malocclusion is characterized by a distal relationship between the maxillary and mandibular teeth. It has several craniofacial and skeletal features.
- Early signs in the deciduous and mixed dentitions include a distal step relationship between the second deciduous molars and transverse discrepancy.
- Treatment in the mixed dentition stage involves using a cervical headgear with facebow to restrain maxillary growth and distalize the upper dentition to achieve Class I molar and canine relationships.
Similar to Halterman technique for the treatment of ectopically erupting permanent first molars (20)
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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12. Comprehend the vectorial analysis of the normal ECG
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1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Halterman technique for the treatment of ectopically erupting permanent first molars
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 12 Ver. II (Dec. 2015), PP 72-78
www.iosrjournals.org
DOI: 10.9790/0853-141227278 www.iosrjournals.org 72 | Page
Halterman technique for the treatment of ectopically erupting
permanent first molars
Muhamad Abu-Hussein*,Nezar Watted**,Azzaldeen Abdulgani ***
*Department of Pediatric Dentistry, University of Athens, Greece
**Clinics and Policlinics for Dental, Oral and Maxillofacial Diseases of the Bavarian Julius-Maximilian-
University Wuerzburg, Germany, and Department of Pediatric Dentistry and Orthodontics Arab American
University, Palestine,
*** Department of Conservative Dentistry, Al-Quds University, Jerusalem, Palestine
Corresponding Author; Dr.Abu-Hussein Muhamad
DDS,MScD,MSc,Cert.Ped,FICD 123Argus Street, 10441 Athens, Greece
Abstract: Tooth eruption is a process whereby the forming tooth migrates from its intraosseous location in the
jaw to its functional position within the oral cavity. Ectopic eruption is one of the problems that arise during the
transitional dentition period.
In this report, the ectopic eruption case was successfully treated with with Halterman type appliance in
2 months. This case report demonstrates that a could with Halterman type appliance provide many benefits over
other traditional treatment modalities and thus could be used for correcting ectopic eruption at an early age.
Keywords: Ectopic eruption, permanent maxillary first molar, Halterman Appliance
I. Introduction
The term ectopic eruption includes those cases in which permanent teeth show abnormal eruption
pattern. Thus, ectopic eruption reflects the eruption of a tooth in an incorrect position (1). The first permanent
molar is considered ectopic when radiographic examination shows superposed image and impaction on the roof
of the deciduous second molar. Therefore, this abnormality can be diagnosed by radiographic examination
before the eruption of the tooth (1,2).
The causes of ectopic eruption are multifactorial, including a genetic component and local factors. The
reported increased prevalence in siblings suggests a genetic component. In fact, a recessive inheritance pattern
with reduced penetrance in girls has been suggested as a mode of inheritance ( 3).
Chapman stated that, for ectopic eruption to occur, the forward movement of the first permanent molar must be
in excess of the downward movement. He suggests one or a combination of three etiological factors(4):
1) the lack of forward movement of all deciduous teeth and bone containing them,
2) the first permanent molar having moved forward prematurely
3) the early eruption of the first permanent molar.
Chintakanon and Boonpinon reported that important etiological factors were the eruption path of the
permanent molars and the size of the mandibular second primary molars. The authors investigated whether the
presence of high interproximal carious lesion reduces the prevalence of ectopic eruption and found no
correlation ( 5).
Harrison & Michal reported that inadequate placement of a stainless steel
crown on the second primary molar is an iatrogenic factor of ectopic eruption of first permanentmolars.
Once the crown is replaced with a properly adapted one, the situation usually self-corrects. (6)
Ectopic eruption of the maxillary first permanent molar has a prevalence that ranges between 0.75 to
4.3% . It is increased by four-fold in persons with cleft lip and palate . A higher prevalence, 19.8%, has been
reported in siblings ( 6). Some authors report a higher incidence in males ( 6), while others found no statistically
significant difference between sexes ( 5).
Early diagnosis of ectopic eruption can be made in children between five and seven years old on a
periapical or bitewing radiograph when the first permanent molar is positioned more superiorly and mesially.
Later in the eruption process, signs of resorption of the second primary molar roots are evident on radiographs.
The first clinical sign of ectopic eruption is the inclination of the occlusal plane of the second primary molar. In
most cases, the distal aspect will be canted occlusally which may result in an anterior open bite ( 6). Frequently,
there will be delayed eruption of the permanent tooth ( 6). In some cases, as the permanent tooth erupts, the
distal cusps will appear first through the gingiva ( 7).
Chintakanon and Boonpinon looked at and found no correlation between the degree of resorption of
the primary molars and the type of ectopic eruption(5). In a more recent study of 36 ectopically erupted molars,
2. Halterman technique for the treatment of ectopically erupting permanent first molars
DOI: 10.9790/0853-141227278 www.iosrjournals.org 73 | Page
a grading system was used to classify the degree of resorption (Figure 3). There was a tendency for self-
correction in the lowest degrees of resorption but this was notstatistically significant (8 ).
Fig.1; Elastic Halterman Appliance
Young classified ectopic eruption of thepermanent first molar into two forms: (1) Reversible; and (2)
irreversible (called “jump” and “hold”). In the reversible form, the ectopically erupting permanent first molar
frees itself spontaneously from a locked position and erupts into occlusion. This reversible pattern occurs in
approximately 66% of ectopically erupting permanent first molars.( 9)In the irreversible form, the permanent
first molar remains in a locked position until
active treatment is provided, or premature exfoliation of a primary second molar occurs. In cases of
premature exfoliation of the primary second molar, a significant
loss of the dental arch occurs, and the permanent first molar often tips mesially with some rotation.(5)
Bjerklin and Kurol noted that the most permanent molars wouldfree themselves and erupt normally by 7 years
of age.(10)
This paper presents a case report with unilateral ectopic permanent maxillary first molar treated with
Halterman type appliance.
II. Case Report
A 5‑year‑old girl came to the private clinic of Pedodontics and Preventive Dentistry for general
check‑up. The patient was in good general health.
Fig.2a; Pre-operative radiograph right side , indication of ectopic eruption of molars, decided to give 6
months to watch.
3. Halterman technique for the treatment of ectopically erupting permanent first molars
DOI: 10.9790/0853-141227278 www.iosrjournals.org 74 | Page
;
Fig.2b; Pre-operative radiograph left side, indication of ectopic eruption of molars, decided to give 6 months
to watch
Extraoral examination revealed no significant findings. Intraoral examination revealed permanent
maxillary left first molar locked beneath the adjacent primary second molar [Figure 2a]. There were no tooth
mobility and no tenderness to percussion in relation to primary second molar. An intraoral periapical radiograph
revealed mesially erupting maxillary left first permanent molar with associated resorption of the primary second
molar [Figure 2a,b]. Correlating clinical and radiographic findings, the left maxillary permanent first molar was
diagnosed as ectopic eruption. It was decided to place Halterman type appliance on second deciduous left
molar extending below the mesial marginal ridge of the first
permanent molar.
Fig.3;Intraoral photo after 6 weeks of wearing the appliance #3 is in a position that the appliance can be
removed.
This appliance consists of a band placed on the second primary molar with a large diameter soft wire
with a distal hook placed 2 mm distal to the clinical crown of the permanent tooth. A tight loop chained elastic
is placed between the distal hook and a button bonded to the permanent molar. The elastic chain creates a distal
force on the permanent tooth[Figure 3]. Follow-up is recommended every 3 weeks. If more correction is needed,
the tension on the elastic may be increased or the appliance may be removed and the wire repositioned more
distally with a three-prong plier. The appliance
4. Halterman technique for the treatment of ectopically erupting permanent first molars
DOI: 10.9790/0853-141227278 www.iosrjournals.org 75 | Page
Figure 4. Modifi ed Halterman appliance with reverse band and loop extension, 2 spurs, and an occlusal bonded
button with chain elastic placed in a slingshot or catapult pattern.
May be removed once the impaction of the first permanent molar is corrected ( 11).
Placing the occlusal button can be challenging in a young mixed dentition patient because of location
and isolation during acid etching and placement of the bonded attachment. To facilitate good retention of the
occlusal button, the author[Figure 4] recommends working with 2 chairside assistants and placing a dry foil in
the corner of the mouth for saliva control. One clinical assistant should be responsible exclusively for isolation,
and the second assistant should facilitate instrument transfer. Light-cured composite is used to retain the
occlusal button because of its quicker set in an area that is difficult to isolate. An alternative would be to use
glass ionomer cement.
Figure 5; Patient was evaluated after 6 weeks of wearing the halterman and the button on the left side
After appliance placement, the chain elastic is changed at 2- to 3-week intervals. If the impacted
permanent molar needs to be moved to the buccal, the chain is applied from the bonded button to the buccal-
soldered spur. For a purely distal movement, the elastic can be stretched from the distal buccal spur to the
bonded button and back to the distolingual spur in a catapult or slingshot design, as shown in[Figure 5] .
Figures 2a,b to 7 show short- and long-term results with this technique. The impaction is usually
corrected within 2 to 4 months , and over correction is recommended . After disimpaction, the chain elastic is
removed and the appliance is left on as the permanent first molar erupts. Once the clinician is assured that the
permanent first molar impaction remains corrected, the appliance is removed.
Fig. 6a: Final photo occlusal view. Fig.6b; : Final photo occlusion
5. Halterman technique for the treatment of ectopically erupting permanent first molars
DOI: 10.9790/0853-141227278 www.iosrjournals.org 76 | Page
Fig.7: Final photo occlusal view
Because root resorption on the primary second molar has occurred, careful monitoring for premature
exfoliation is necessary. Provided there is adequate space and no premature loss of the primary maxillary second
molar, there is satisfactory eruption of the permanent dentition (Figure 6a,b,7).
III. Discussion
The purpose of this paper was to report the clinical case of a patient with ectopic eruption of a maxillary
first permanent molar, focusing on the main clinical and radiographic features of the case, as well as its
treatment(12).
Untreated irreversible ectopic eruption of first permanent molars may cause premature loss of the
primary second molar and result in unfavorable occlusion and space deficiency for the second premolar ( 13).
Less frequently abscess formationand pain may occur ( 1). On the other hand, if the molar is self-correcting,
treatment is unnecessary. Delivering treatment when not indicated may be detrimental, cause bacterial
infiltration, increase the risk of infection and accelerate the loss of the primary tooth. If an unnecessary
treatment is provided, cost and time of the patient and the practitioner are exhausted ( 4). Therefore, proper
diagnosis of the type of eruption is crucial for the delivery of appropriate treatment. Unfortunately, this is a
challenging task, as no definitive criteria have been established to accurately predict the outcome. However, a
few authors have presented guidelines and recommendations to aid in determining when to intervene(3).
Some authors demonstrated that the ectopic eruption of the maxillary first permanent molars can occur both
unilaterally and bilaterally (1,10). Barberia-Leache et al. described a higher frequency for the right side, when
the eruption is unilateral (8). The case reported in this paper involved the right side of the arch, in a unilateral
pattern. This higher frequency of the right side, when the condition is unilateral, is difficult to explain, but, like
in other multifactorial anomalies, there is a variation in the frequency of sides. However, there are also reports
showing no difference in distribution between sides (10).
Some studies describe a higher prevalence of ectopic eruption in maxillary molars (3,11,12). Therefore,
the case described herein is in accordance with the most common clinical manifestation described in studies,
since it involved a maxillary molar.Different factors have been associated with the etiology of this abnormality
(2-10), and the negative model discrepancy observed in this case may be associated with the described ectopy.
Traditionally, various techniques such as elastic separators, brass wire, or Halterman appliance have been used
for correction of ectopically erupting permanent first molar.[8] In most cases, however, separator or brass wire
alone is not effective since the amount of space that could be created is limited. Kennedy and Turley have
described different modalities for clinical management of ectopic permanent molars.
They recommended that when primary molar hassuffered excessive resorption and is symptom free, it
could be used as abutment tooth for a Halterman type appliance.[9,10] Although Halterman type appliance is
effective, but it is bulky, requires additional lab procedures and necessitates preparation of the
occlusal surface of permanent first molar.[10] Kennedy recommended modified Halterman appliance, which is a
reverse band and loop appliance with a bonded button on the permanent molar and chain elastic for
disimpaction. However, the appliance required changing of chain elastic at 2–3 weeks interval. In addition,
taking an accurate impression of the hamular notch and good communication with the lab was mandatory with
this modified appliance.[2]
In a study conducted on 126 cases of ectopic eruption, Bjerklin and Kurol observed that in
approximately 90 % of cases, the type of ectopic eruption could be assessed during the child’s 7th
year of
life(3,10). The remaining 10% were assessed between 8 and 9 years of age. In case of doubt, the authors
recommend postponing treatment for a few months ( 3). Young stated that self-correction can occur between 6
months to 2 years after diagnosis of ectopic eruption ( 9). Most authors recommend an observation period of 3
to 6 months from diagnosis before intervening ( 13). On the other hand, initiating treatment early may afford a
better chance for proper alignment and positioning of the permanent tooth. Far more potential harm to the
primary and permanent molars is risked if clinical treatment is postponed ( 6).
In 1987, Kennedy and Turley proposed a flow-chart to determine when to initiate treatment, based on
factors such as the clinical eruption status of the permanent tooth, its change in position, the amount of ledge of
the primary tooth entrapping the permanent molar, the mobility of the primary tooth and the presence of pain
and infection . In these guidelines, the treatment recommended depends primarily on the amount of enamel
6. Halterman technique for the treatment of ectopically erupting permanent first molars
DOI: 10.9790/0853-141227278 www.iosrjournals.org 77 | Page
ledge created by the root resorption of the primary molar ( 13). However, to date, the amount of resorption of
the primary roots has not been shown to have a statistically significant relationship with a specific outcome.
Treatment may be classified into three main categories: minimal intervention, appliance therapy with
retention of the primary second molar and appliance therapy with extraction of the second primary molar ( 15).
Interproximal wedging consists of creating a separation between the mesial surface of the permanent
first molar and the distal surface of the second primary molar to allow the permanent molar to free itself from
the undercut of the primary tooth. This can be done with an elastic separator, a brass wire or a spring and is
indicated as an initial treatment or when the impaction of the permanent molar does not appear severe. These
wedging techniques have many advantages: they generally minimize chair time, they do not require impressions
or laboratory procedures and they do not damage the permanent teeth ( 14). Other minimal interventions include
gingivectomy to expose of the permanent tooth and disking of the distal surface of the primary second molar.
If the permanent molar is not erupted, the brass wire technique may be used. This technique requires
local anesthesia. A brass wire is threaded through the interproximal area and looped around the marginal ridge
of the permanent molar. Both ends of the wire are twisted until snug and tucked into the interproximal area to
avoid discomfort. The wire must encircle the contact area. A bitewing radiograph is taken to confirm the correct
placement of the wire. The patient is seen at regular intervals to tighten the wire. The wire may be removed once
it slips through the contact during tightening ( 12). This technique may result in infection or early loss of the
primary molar, therefore careful supervision is recommended ( 1).
The simplest treatment consists of placing an orthodontic separating elastic between the primary
second molar and the permanent first molar. Topical anesthetic may permit more comfortable placement of the
elastic ( 16). Placement with waxed floss instead of pliers may prevent damage to the gingiva. The elastic must
be replaced every 7 to 14 days until there is overcorrection of the impaction. Spontaneous loss of the separator
indicates correction (17-20 ).
Evidently, the tooth must have emerged somewhat from the gingiva to allow for proper positioning of
the elastic. A triangular helical spring has been described as an adjunct to the elastic separator technique. It is
suggested that the space created by the brass wire or the elastic separator is limited and therefore not effective.
A spring composed of three helical loops in a triangular shape is thus fabricated and inserted between the
permanent first molar and the second primary molar. The wedging spring should be reactivated or replaced
every 3 weeks ( 18,19,20).
Harrison and Michal observed that in minimal lock cases, self-correction occurred more frequently
and more quickly after surgical exposure. They also recommend surgical exposure of the first permanent molar
if it is positioned very high to avoid the use of any appliance. Self-correction should be observed within 3 to 4
months, if the condition has not improved, appliances are used ( 6).
One of the limitations of this appliance is that the part of ectopically erupting tooth should be visible so
that bonding of the button could be done and the adjacent primary second molar should not be grossly carious.
Future studies are required to assess the performance of this appliance in cases of ectopically erupting
mandibular permanent molars. (Figure 6a,b,7)
IV. Conclusion
Ectopic molars are usually predictors of a future discrepancy between tooth size and arch length; an
orthodontic referral may be indicated .The diagnosis of suspected cases of ectopic eruption of first molars may
be performed even before the eruption of these teeth by taking radiographs of the area. In this situation, the
periodic follow-up of the patient is greatly important, in order to prevent clinical sequelae resulting from this
condition.
References
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