Successful treatment of multiple bilateral impactions - a case report
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CASE REPORT
Open Access
Successful treatment of multiple bilateral impactions - a case report Michael Schubert1, Peter Proff2 and Christian Kirschneck3*
Abstract Background: Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. Case presentation: In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. Conclusions: The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time. Keywords: Case report, Diagnosis and treatment planning, Impaction, Guided eruption
Background A successful treatment of cases with multiple impactions poses a major challenge for most orthodontists in clinical practice and requires a meticulous treatment planning, preferably in collaboration with a dental surgeon. Apart from complicating the treatment and its predictability [1], treatment times usually increase significantly [2–4] and there is considerable concern that the impacted teeth could show or develop signs of invasive cervical root resorption (ICRR) or ankylosis [5], leaving the patient in the long term with a distinct hypodontia, if an extraction of these teeth becomes necessary. Following the impaction probability of wisdom teeth, upper canines are the most likely teeth to be impacted, with a chance if about 1.59 % in the general populace, followed by lower second premolars, upper central incisors and the lower first premolar [6]. By contrast, impacted mandibular canines have a chance for impaction * Correspondence: [email protected] 3 Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany Full list of author information is available at the end of the article
of only 0.35 % [7]. Since the occurrence of impacted maxillary canines is quite frequent, many studies have described successful treatment plans for aligning these teeth, in most cases involving a combined surgicalorthodontic approach [8–13]. However, due to the sporadic occurrence of additional impacted teeth in non-syndromal patients (about 0.32 % [6]), only a few studies report problems and treatment strategies [
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