Orthodontic Tips April 19, 2011
I’m excited about this one.
Teeth need normal bone metabolism for orthodontic movement.
We used to think that if a cuspid was impacted in the maxilla (or mandible) that if you exposed part of the crown applied enough pressure in the right direction, the tooth would move into the mouth.
Although the technique worked some of the time, many times the cuspid got stuck or the gingiva never formed properly around the tooth.
Studies by Kokich showed that once the eruption follicle around the crown of a tooth is opened, there will be no further bone metabolism around the crown of the tooth. Only the root, surrounded by the periodontal ligament, retains the ability to support normal bone metabolism.
I have been using his technique successfully for the past three years.
Here is a case that was started by an orthodontist who was not aware of this information. The tooth 2.3 was uncovered partially, leaving only enough enamel showing to bond a button in place. Of course it did not move at all.
When Dr. Gerry Pearson uncovered the tooth last week, we discovered that the apex and the mesial and distal line angles were still covered in bone. In addition there was fibrous tissue around the crown as evidence of necrotic bone from the attempts at orthodontic movement.
These pictures will show that we exposed all line angles of the crown and then packed it with peri-pack.
I expect successful positioning of this tooth now.
Have a great week.
Dr. Stan Waese