Crowding Complicates - Expose and Bond Tooth #6 and #11

The interesting case that I'd like to discuss today is a case of an impacted tooth number 6 and 11. This young lady has crowding, and not enough room in her dentition for all of her teeth. Tooth number 6 and 11 are crowded out of the arch. I saw this patient to expose, and to bond, these teeth.

Now, I remember back in the good old days, when we would get these cases, we would do these things called shift shots and thank goodness for the cone beam scanner, because the days of the shift shot have long since passed.  So now, instead of trying to figure out, using the SLOB rule same-lingual opposite buccal to see whether the tooth is more towards the palate, or more towards the facial, I can just take a cone beam scan. I can take a look at this thing in three dimensions, and see where each of those teeth are, and appropriately go after those teeth to expose them.

If you click HERE, you will find pictures that are the cone beam scan ... that show, in three dimensions, the positioning of tooth number 6 and 11, and the retained primary tooth number C and H.

This patient was sedated. Tooth number C and H were removed, and an incision was made on the facial aspect in the vestibule. A full-thickness mucoperiostial flap was raised, and a thin layer of bone covering the crown of the tooth was removed, and the tooth was exposed completely down to the cementoenamel junction.

Once it was exposed, it was isolated ... and I like to take a small two-by-two gauze, soak it in one carpule of 2% lidocaine with 1 in 100,000 epinephrine, and pack it in this area. This really helps with hemostasis. The area is isolated, dried. The tooth is acid etched using phosphoric acid, irrigated copiously, and then, some adhesive is applied. A gold mesh with a chain is then bonded to this tooth.

This mesh is then secured, ideally, to an arch wire ... and if an arch wire isn't present from ortho, then I will just use a 28 gauge wire and loop it around the neighboring tooth and secure the chain to that tooth, making sure that the chain is short enough that it doesn't interfere with the patient's function, and occlusion, in the meantime, prior to them getting the orthodontic arch wires.

I also did an apically repositioned flap, and tried to make my incision to pull some attached gingiva, apically and then suture this using 3-0 chromic gut suture in the vestibule, keeping those teeth exposed. The area is then packed with gauze, and instructions are given on how to keep the area clean, and to keep the tooth exposed. Then, the tooth is basically ready to be activated, and to be pulled into the arch. This patient tolerated the procedure quite nicely, and is currently undergoing active orthodontic care to erupt this tooth into the arch.

For the full "Crowding Complicates - Expose and Bond Tooth #6 and #11" podcast episode click here.

For more interesting cases, and to listen to more full episodes visit DentistBrainCandy.com or text "CANDY" to 77948