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Treatment of a neutroclusion mutilated case
‘l’RBlA’l’Ml3NT
OF A NEUTRCKLUSlC)N
MUTI TJATEI) CAS 14”
T
HIS patient is a girl; she was nine years of a.ge at the time of presenting for treatment. It was found upon examination that all lat.eral incisors and all second premolars were missing as well as both ma,xillary second molars. In addition there was a marked rotation of the maxillary first molars. The maxillary canines were found in the palatine portions of the maxilla with the tip of the cusp in each case almost in conta,ct with the apex of the root of the central incisor teeth. The mandibular canines were imbedded in the anterior portion of the mandible with their cusps approaching one another, as shown in the x-ray pictures in Fig. 2. Proposed Treatment.--It was decided to rotate the molar teeth to their normal position; to leave all deciduous teeth in place with the exception of the maxillary deciduous lateral incisors. After bringing both maxillary and mandibular central incisors together, a portion of the crown of each canine was to be exposed. Then the canines were to be placed in position next to the central incisors, letting the deciduous canines occupy the space normally occupied by the permanent canines. The reason for this was to conserve those deciduous teeth which were present and by utilizing the canines in t,he place of lateral incisors to eliminate, as far as nature might permit, the need for artificial teeth in these areas. Treatment.-Angle bracket bands were placed on the maxillary and mandibular incisors, 0.020 inch round wire loop spring with ends soldered to small sections of ribbon arch wire was placed and the space between the incisors was closed. Sections of ribbon arch wire were used in the ends of the round wire to prevent the spring from rotating labially. After these spaces were virtually closed a lingual arch appliance was constructed for the maxillary arch and contoured anteriorly to permit an auxiliary wire to be attached over, first, the right canine and then the left. The right canine crown was exposed under local anesthesia and the area packed with a mixture of zinc oxide and eugenol. The lingual arch was inserted with auxiliary wire extending over the zinc oxide and eugenol packing to maintain it in position. At the end of two weeks, the lingua.1 arch was removed, the packing likcwise; then a plaster impression of the exposed portion of the canine was taken; the a,rea was again packed with zinc oxide and eugenol and the lingual arch replaced. A gold casting was then made from the impression of the canine. A small eyelet was soldered to the casting, and about four days later upon the removal of the lingual arch and the packing, the, casting was cemented in place. The next day the lingual arch was replaced with an auxiliary spring attached *Presented at the Thirty-Second Oklahoma City, November, 1933.
,Innual Meeting of the American
Society of Orthodontists,
Fig.
1
lingual arch was in use ~II t Lc mandible. The procedure in drawing up thr right mandibu1a.r canine was identical with that for the maxillary canine with the exception, of course, that the auxiliary spring was attached to the labial wire. About six weeks after cementing a cap on the mandibular right, canine, the, mandibulas left canine was tlxposed and the same procedure followed out with that. This ma.ndibular labia.1 wire was 0.040 inch in diameter and extended from the ma.ndibular first mola:* OII one sidts lo the mandibular central incisors which were h.eld in place by a. section of ribbon a.rch. This heavy labial wire was adjusted at intervals of from three to four weeks to produce a rot,ation of the mandibular right first mola,r. Tdikewise on the maxillav lingual such, ad-
Treatment
of a Neutroclusion
Mutilated
Case
647
justments were made to ca.rry on rota,tion of the maxillary first molars, aal of this being carried on while usin g these base wires t,o bring the impant,ed teeth into position. Treatment was started in January, 1929, and concluded in April, 1932. Figs. 1, 2, and 3 show the models and x-ray pictures of the case before keatment and fourteen months after concluding active treatment. The patient has been wearing a removable retaining device on both maxillary and mandibular arches. Fig.
2.
Fig.
3.
DISCUSSION
Dr. Ado M. Dunn, Onzaha, Neb.--I ~voulci suggest that a number of radiograms be taken from several positions to determine the location and the true relationship of the impacted canines with the surrounding teeth. This information is an aid in determining the location of attachment so that force may be applied in the proper direction. Kadiograms should also
OF A NEUTRCKLUSlC)N
MUTI TJATEI) CAS 14”
T
HIS patient is a girl; she was nine years of a.ge at the time of presenting for treatment. It was found upon examination that all lat.eral incisors and all second premolars were missing as well as both ma,xillary second molars. In addition there was a marked rotation of the maxillary first molars. The maxillary canines were found in the palatine portions of the maxilla with the tip of the cusp in each case almost in conta,ct with the apex of the root of the central incisor teeth. The mandibular canines were imbedded in the anterior portion of the mandible with their cusps approaching one another, as shown in the x-ray pictures in Fig. 2. Proposed Treatment.--It was decided to rotate the molar teeth to their normal position; to leave all deciduous teeth in place with the exception of the maxillary deciduous lateral incisors. After bringing both maxillary and mandibular central incisors together, a portion of the crown of each canine was to be exposed. Then the canines were to be placed in position next to the central incisors, letting the deciduous canines occupy the space normally occupied by the permanent canines. The reason for this was to conserve those deciduous teeth which were present and by utilizing the canines in t,he place of lateral incisors to eliminate, as far as nature might permit, the need for artificial teeth in these areas. Treatment.-Angle bracket bands were placed on the maxillary and mandibular incisors, 0.020 inch round wire loop spring with ends soldered to small sections of ribbon arch wire was placed and the space between the incisors was closed. Sections of ribbon arch wire were used in the ends of the round wire to prevent the spring from rotating labially. After these spaces were virtually closed a lingual arch appliance was constructed for the maxillary arch and contoured anteriorly to permit an auxiliary wire to be attached over, first, the right canine and then the left. The right canine crown was exposed under local anesthesia and the area packed with a mixture of zinc oxide and eugenol. The lingual arch was inserted with auxiliary wire extending over the zinc oxide and eugenol packing to maintain it in position. At the end of two weeks, the lingua.1 arch was removed, the packing likcwise; then a plaster impression of the exposed portion of the canine was taken; the a,rea was again packed with zinc oxide and eugenol and the lingual arch replaced. A gold casting was then made from the impression of the canine. A small eyelet was soldered to the casting, and about four days later upon the removal of the lingual arch and the packing, the, casting was cemented in place. The next day the lingual arch was replaced with an auxiliary spring attached *Presented at the Thirty-Second Oklahoma City, November, 1933.
,Innual Meeting of the American
Society of Orthodontists,
Fig.
1
lingual arch was in use ~II t Lc mandible. The procedure in drawing up thr right mandibu1a.r canine was identical with that for the maxillary canine with the exception, of course, that the auxiliary spring was attached to the labial wire. About six weeks after cementing a cap on the mandibular right, canine, the, mandibulas left canine was tlxposed and the same procedure followed out with that. This ma.ndibular labia.1 wire was 0.040 inch in diameter and extended from the ma.ndibular first mola:* OII one sidts lo the mandibular central incisors which were h.eld in place by a. section of ribbon a.rch. This heavy labial wire was adjusted at intervals of from three to four weeks to produce a rot,ation of the mandibular right first mola,r. Tdikewise on the maxillav lingual such, ad-
Treatment
of a Neutroclusion
Mutilated
Case
647
justments were made to ca.rry on rota,tion of the maxillary first molars, aal of this being carried on while usin g these base wires t,o bring the impant,ed teeth into position. Treatment was started in January, 1929, and concluded in April, 1932. Figs. 1, 2, and 3 show the models and x-ray pictures of the case before keatment and fourteen months after concluding active treatment. The patient has been wearing a removable retaining device on both maxillary and mandibular arches. Fig.
2.
Fig.
3.
DISCUSSION
Dr. Ado M. Dunn, Onzaha, Neb.--I ~voulci suggest that a number of radiograms be taken from several positions to determine the location and the true relationship of the impacted canines with the surrounding teeth. This information is an aid in determining the location of attachment so that force may be applied in the proper direction. Kadiograms should also