Articles

Treatment of traumatic loss of the upper central incisor with unilateral mesialization

Objectives  Traumatic dental injuries represent a major public health problem, poten­tially affecting growth, function and aesthetics of the entire orofacial dis­trict and impacting oral-health-relat­ed quality of life, with relevant social and psychological aspects.

It is estimated that the 80% of all traumatic dental injuries occurs in children and adolescences within 20 years of age, patients in which implant-positioning is not recom­mended, if not contraindicated. Many therapeutic alternatives for these group of patients have been described in literature, going from removable prosthetic appliances to Maryland-bridges and other fixed prosthetic appliances supported by orthodontic miniscrews. All these solutions appear to be temporary, requiring a second treatment once the patient’s growth has ended.

The aim of this report is to de­scribe the combined orthodontic and prosthetic treatment of a trau­matic dental injury-related upper incisor loss in a young patient.

Materials and methods  An 11-year-old boy presented with the loss of the permanent upper left central incisor, complaining chiefly of his unpleasant smile aes­thetic. The complete documenta­tion of the case was collected, in­cluding intra and extraoral photos, dental impressions and a CBCT scan. No agenesis was found, based on a panoramic radiography. Cephalometric analysis showed a normo to hypodivergent path of growth, with skeletal first class and average overjet and overbite.

He was proposed the mesialization of the entire upper left hemiarch and the prosthetic enhancement of all teeth of the second sextant. The orthodontic treatment lasted four and a half years and did not re­quire skeletal anchorage. Intermax­illary elastics were the main anchor­ing system, used asymmetrically to obtain and then finalize the patient’s occlusion.

At the end of the ortho­dontic treatment the patient under­went the prosthetic treatment: since he could not afford the enhance­ment of all upper frontal elements, only the camouflage of element 2.2 in element 2.1 was made, using a ceramic dental veneer.

Results and conclusions  The final occlusion was asymmet­ric, with molar and canine first class on the right side and molar and ca­nine class two on the left side. Overjet and overbite were main­tained within average values. A mild midline deviation was present, but within clinical acceptability limits.

Considered the patient’s hypodiver­gent growth path, slightly altered gingival margins and emergence profiles were not seen as repre­senting a problem. The patient and his parents were both satisfied with the treatment outcome.

Clinical significance  Orthodontic space closure can be a valid and definitive therapeutic al­ternative in a young patient, not yet suitable for fixed prosthetic appli­ances, in case of loss of one or two teeth, especially in the upper ante­rior sextant. A good collaboration between orthodontists and prost­hodontists is needed for the suc­cess of this therapy.

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Table of Content: Vol. 89 – Issue 04 – Aprile 2021