The impacted maxillary canine: II. Clinical approaches and solutions.
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This article describes a combined surgical-orthodontic method to manage impacted teeth, primarily maxillary canines. The method uses a modified type of ligation chain that enables the oral surgeon to lasso the tooth with ease and affords the orthodontist large, successively placed eyelets to which he can easily tie elastic thread in order to keep continuous heavy force pulling the tooth toward the oral cavity.
Infectious dental complications are quite frequent given the high incidence of tooth decay. Other pathologies not related to dental decay can cause mouth infectious such as periodontal infections, alveolitis, peri-coronitis of impacted wisdom tooth and secondary infection of dental fragments. Dental infection can be localised to apex (top of the root) or progress to soft and bony tissues surrounding the teeth. The most frequent germs involved in these infections are generally the same as saprophyte buccal flora but are often associated to other anaerobic germs. The following complications will be described in what concerns their etiology, pathology and treatment: abcess, fistula, phlegmon and cellulitis, odontogenic cysts, actinomycosis, craniofacial thrombophlebitis, osteitis and osteomyelitis, maxillary sinusitis, septicemia and local odontogenic infections. The consequences of these infections can vary according to immunologic resistance of the patient as well as the resistance of some germs to the most common antibiotics. Several factors should be taken in consideration in the treatment; patient history factors, germ virulence, maintaining or suppression of etiologic factors and drainage possibilities.
Impaction of mandibular second molars is relatively rare. A case of a deep impacted mandibular right permanent second molar in a 26-year-old woman is presented. This article describes the extraction of the tooth and reports the risks of the surgical procedure. Careful manipulation of tissues and correct application of mechanical principles involved in tooth extractions allowed surgical success.
To align those teeth in the dental arch that cannot erupt or are displaced, they must be surgically exposed. After the traction device is attached, the tooth is again covered with the mucoperiosteal flap to protect the tissues involved. For this reason, the loss of this traction device must be absolutely avoided in order to prevent another surgical intervention. Here at the University of Ulm, we have developed and tested an optimized traction chain for that purpose. The chain is attached to the tooth with a laser-roughened pad applying the acid-etching technique. The chain links serve as fixation elements for traction devices such as elastic ligatures or piggyback archwires. At the same time, one can determine the distance covered by the tooth by the number of the erupting chain links. We demonstrate the clinical application of this traction device in two cases.
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