Clinical Study Of Multiple Impacted Teeth Of The Design And Treatment With CBCT

Objective: To provide clinical reference of the multiple impacted teeth to orthodontic design and treatment by cone beam computed tomographic.Materials and methods:From 2012 to 2015,there are 30 patients with impacted teeth in Shenyang Stomatological Hospital.Three patients were selected with complex impacted teeth,a total of 8 impacted teeth.Patients get the skull,jaw,dental arch three-dimensional images,so as to design the corresponding treatment plan through clinical examination,CBCT examination,analysis of cephalometry pre-therapy.By comparing the bone mass around the impacted teeth,gum morphology and results of cephalometry,a comprehensive evaluation has been made to analysis of the treatment outcome of complex impacted teeth.In this study,three cases of patients were chosen with complex embedded teeth.Case 1:Pairs of maxillary impacted canines with lateral incisor absorption,female,12 years old,the skeletal Class III,low angle;Angle class II subdivision;premolar area of open bite 2mm.CBCT showed 13 23 was impacted in the upper jaw and 12 21 22 had root resorption.The bone mass were measured around 1323 by CBCT,which were enough to orthodontic traction.The patient suggested to beorthodontic traction indication,so the patient with straight wire appliance technology,extracted 12 22 34 44,tow 13 23.Case 2:Two adjacent impacted teeth of mandibular,Male,20 years old,skeletal Class III,high angle;Angle Class III;There were 2mm of maxillary crowding and 2mm of mandibular crowding;Anterior teeth on edge,posterior teeth is less overbite and overjet;The maxillary and mandibular midline was deviated to left 1 mm and to right 1mm.Individual teeth is crossbite,53 83 84 stranded.X-ray showed 43 44 both impacted in the mandibular and overlap,there was a round area of the bone in the right lingual side of the mandibular,no wave and no pain.Both impacted teeth can not be touched directly in the mouth.The patient who meet the standards for orthodontic traction was adopted the none extraction.Case 3:Multiple impacted anterior teeth of maxillary,female,10 years old,the skeletal Class III,normal angle;Anterior teeth on edge,widely permanent teeth were delayed eruption.CBCT showed 13 impacted mesial,21 22 23 continuous lying in the upper jaw and they had different axial angle,no missing teeth and multiple teeth.21 crown root into angle,palatal bone of 22 is thin,23 impacted deeply and parallel to the occlusal surface.In patients’ parents strong demand and signed with informed consent,we would take orthodontic traction in order to restore the integrity of the teeth and make sure the anterior teeth esthetic as far as possible.All the three cases are recorded from the orthodontic treatment tracting the impacted teeth to the occlusal surface.Results:Case1,after 31 months(traction 20 months)treatment;Case 2,after41months(traction 32 months)treatment;Case 3,after 35 months(traction 25months)treatment,8 impacted teeth were successfully towed to the occlusal surface.(1)Evaluation of bone mass around the impacted teeth: after treatment there were moderate bone tissue around the 8 impacted teeth,and the height of alveolar bone around the impacted teeth were more than that of the 1/3 height of root after treatment.all of them were stability.(2)Evaluation of measurement indexes after treatment:in the arch,dental axis was ideal,continuous arch,no root resorption and crown discoloration.(3)Evaluation of gum morphology after treatment: aftertreatment,3 cases,fine colour and lustre of gum,gum margin continuity,tight tough flexible,no abnormal.The correct jaw relationship is beneficial for the patients oral cleaning and improvement of oral health.Conclusion: For patients with multiple impacted teeth,aaccurate treatment plan was made by assessment of the development of the impacted teeth,and the relationship with adjacent teeth,the surrounding bone mass through CBCT examination.In orthodontic treatment,leveling and alignment of teeth column provides the necessary space for impacted teeth.It also attained gum health and beauty after fenestration,via accurate adhesive attachment,reasonable use of anchorage and paying attention to the traction force and direction.Satisfactory effect,such as fine gum morphology,moderate bone tissue,no discoloration of teeth and tooth root absorption,can be obtained through reasonable examination and well treatment plan for multiple impacted teeth cases.