Surgical-orthodontic Treatment Of The Impacted Maxillary Anterior Teeth With Odontoma

Objective:The purpose of this study was to investigate the effects of surgical-orthodontic treatment in the right impacted maxillary anterior teeth with odontoma using non-conventional extraction.Material and Methods:The first case was hospitalized in August 2015,who was 18 years old and impacted maxillary anterior teeth with odontoma.Jaw normal,skeletal class I,high angle.The extraoral examination showed her face was symmetrical.The maxillary dental midline deviated 4 mm to the right.Meanwhile,the profile was straight,the nasolabial angle and mentolabial sulcus were normal.Over jet and over bite both were normal,the left canine occlusal was class III relationship.The crowding of maxillary arch was IIIo,the crowding of mandibular was IIo.Spee curve was 0mm.11?12?13 were impacted with odontoma,36?46 were residual roots.By analysis of patient with type surface fault analysis,projection measurement analysis and CT 3D reconstruction analysis,the patient was the right labially impacted maxillary anterior teeth with odontoma.And the patient was treated by extraction of the right maxillary lateral incisor ? the odontoma and the mandibular first molars' residual roots with surgical-orthodontic treatment.Orthodontic treatment technology using Straight Arch Wire Technique,obtained the positive over jet and over bite at the end of this phase.Maximum anchorage was used to align and level the dentition.Wirebending for finishing adjustment when the occlusal was normal and Hawley retainers for upper and lower.According to the pre and post treatment cephalometric radiograph was done to judge the changes of soft and hard tissue before and after treatments.The second patient was 13 years old and left impacted maxillary canine and lateral incisor teeth with odontoma.Jaw normal,Angle's class ?malocclusion.The extraoral examination showed her face was symmetrical.The maxillary dental midline deviated 4 mm to the left relative to the facial midline,and mandible was 2mm to the left.Meanwhile,the profile was straight,the nasolabial angle and mentolabial sulcus were normal.Over jet was I o and over bite was normal.The crowding of maxillary arch was IIo,the crowding of mandibular was Io.Spee curve was 2mm.22?23 were impacted with odontoma,63 was retention.By analysis of patient with X-ray and CT: 22?23 were impacted with odontoma in palate.And the patient was treated by extraction of the 23 ? 63 and the odontoma with surgical-orthodontic treatment.Orthodontic treatment technology using Straight Arch Wire Technique,smoothed the denture,and tongue retainers for upper.Results: The first course of orthodontic treatment was 18 months,the labially impacted maxillary canine and incisor were moved to their original position,smoothed the denture,obtained the positive over jet and over bite at the end of this phase.Maximum anchorage was used to align and level the dentitio and keep the side of the face.The maxillary dental midline deviated to the right relative to the facial midline.The arthrosis ? open shape ? open extent were normal.The panoramic radiograph was showed: the alveolar bone around the impacted has a little decrease,but the other roots and alveolar bone did not be seen.Periodontal state of dentition was good.The bone of odontoma was get right,no palindromia.According to the pre and post treatment cephalometric radiograph was showed: Bilateral condylar position is good,have no obvious change,embedded teeth and bone around the adjacent teeth is normal,no obvious absorption.The U1-SN(o)?U1-NA(o)?U1-NA(mm)?IMPA(o)?L1-NB(o)?L1-NB(mm)? UL-E(mm)? LL-E(mm)? ULP(mm)? LLP(mm)were increased and the NLA(o)? Z angle(o)were decreased.Before and after treatment the overlap show: there was no significant alteration of the upper and lower jaw,top andbottom lip.The flank was not changed obviously.The patient and her family were satisfied with the result after orthodontic treatment.The second course of orthodontic treatment was 12 months,the labially impacted maxillary lateral incisor was moved to the original position?Conclusion: For this patient,who has multi-impacted maxillary anterior teeth in same position,the impacted interrelationship,when the treatment was affected the near teeth led to roots lesion even resorption,we can get a good therapeutic eddect by using surgical-orthodontic treatment with non-conventional extraction.Odontoma is benign tumor,is not easy to relapse after resection,often with embedded teeth,traction and embedded teeth operation timely to avoid damage and failure.Teenagers maxillary anterior teeth in patients,should be given priority to with conservative treatment,through surgery and orthodontic treatment to retain the autogenous tooth.At the same time,avoid late repair tooth extraction treatment and would acquire satisfied treatment result.