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Anomaly of upper right central incisor
526
ADOLPH JUTKOWITZ
7. The immediate placement of the guide plane favors normal breathing instead of mouth-breathing, due to the estab]ishment of a normal position of the jaws and lips. 8. It tends to break tongue habits, lip-biting, thumb-sucking, and other harmful habits. 9. Failure, due to lack of cooperation in wearing elastics, is overcome. A patient may wear elastics or leave them off, and the bite remains the same. 10. Other treatment can be carried out simultaneously, as the bite is being changed. It is common practice to expand the upper arch and move the upper anteriors back, and to rotate them, while the guide plane is in position. 11. In the troublesome " d u a l bite" condition, there is a distinct advantage over elastics, as the patient cannot change from one bite to another. Of course, in all of the uses of the occlusal guide plane, just as w i t h any appliance, regardless of rules set forth, some degree of common sense and application is necessary. It is not within the province or laws of man to meet in every instance, without variation, the requirements of nature. 1101 MEDICAL'ARTs BUILDING
ANOMALY OF U P P E R RIGHT CENTRA~L INCISOR CASE REPORT
ADOLPH JUTKOWITZ,
B.S., D.D.S., a NEW YORK, N. Y.
H E case to be presented is of interest because it concerns an anomaly in the formation
T of the upper right central incisor.
The patient, W. G., a boy 9 years 2 months of age, presented himself for the correction of a malocclusion and because his upper right central incisor was not completely erupted. Figs. 1 and 2 show a photograph o f the teeth and casts of the case previous to starting treatment. I n fact, when the boy was first seen, only the two opposing corners of the tooth were visible, giving the appearance of two separate teeth erupting. The upper right lateral incisor was erupting to the lingual and it appeared as though it were a supernumerary tooth. X-rays were taken and it was found (Fig. 3) that the upper right central incisor had a very large crown made up of two parts which appeared fused for most of its length from the incisal to the gingival portions, with two separate roots and two separate pulp chambers and root canals. The upper right permanent lateral incisor and cuspid were present. The upper left permanent central incisor and lateral incisor were in lingual version. The history revealed nothing which could account for the anomaly. The boy's father seemed to think t h a t a fall which the boy had suffered when he was 21~ or 3 years of age might have been a contributing factor. This is disproved by the fact that the incisal half of the central incisor crown is calcified before that age is reached. I t was decided to first correct the positions of the upper left Central and lateral incisors. Bands were placed on the upper first permanent molars with horizontal buccal tubes into which a labial arch, 0.040 inch in diameter, was placed. By the time these teeth were put, into their correct positions, the anomalous central incisor had erupted completely. Since the tooth presented two separate pulp chambers and two separate roots it was decided to separate the two parts of the crown by cutting through the fused postion with carborundum disks. The mesial part of the tooth was to be brought mesialiy and was to ocdupy *Assistant Professor, Department of Orthodontics, New York University, College of Dentistry.
ANOMALY
OJs' U [ ' I ' E R RI(IIIT
F i g . 1.
Fig'.
2.
CENTRAL INCISOR
527
528
ADOLPH JUTKO~VITZ
Fig.
4.
F i g . 5.
Fig. 6
ANOMALY OF UPPER RIGHT CENTRAL INCISOR
529
the position of the right central incisor while tlle distal portion was to be extracted. Four months after beginning the orthodontic treatment this separation was done. The orthodontic treatment was continued as planned and the upper right lateral incisor was placed in its proper position. Fig. 4 is a photograph showing the mesial part of the central incisor in its proper position prior to extracting the distal portion. Fig. 5 is a photograph after the treatment was completed showing the upper lateral incisor in its correct position. lq'o attempt was made to move the right lateral incisor into position until the distal half of the central incisor was extracted.
Fig. 7. The mesial portion of the central incisor has maintained its vitality and at a suitable time will have a porcelain jacket crown placed on it to match the opposing tooth. Fig. 6 shows the casts at completion of treatment, and Fig. 7 shows the x-rays. The significant facts with regard to this case are: (1) some anomalous tooth forms can be so controlled as to make them, or portions of them, serviceable units of the dental arch; and (2) observation of cases during developmental periods make it possible to resort to relatively simple procedures for the prevention of complicated malocclusions. I wish to thank Dr. Hemley for his cooperation in planning the treatment for the patient.
ADOLPH JUTKOWITZ
7. The immediate placement of the guide plane favors normal breathing instead of mouth-breathing, due to the estab]ishment of a normal position of the jaws and lips. 8. It tends to break tongue habits, lip-biting, thumb-sucking, and other harmful habits. 9. Failure, due to lack of cooperation in wearing elastics, is overcome. A patient may wear elastics or leave them off, and the bite remains the same. 10. Other treatment can be carried out simultaneously, as the bite is being changed. It is common practice to expand the upper arch and move the upper anteriors back, and to rotate them, while the guide plane is in position. 11. In the troublesome " d u a l bite" condition, there is a distinct advantage over elastics, as the patient cannot change from one bite to another. Of course, in all of the uses of the occlusal guide plane, just as w i t h any appliance, regardless of rules set forth, some degree of common sense and application is necessary. It is not within the province or laws of man to meet in every instance, without variation, the requirements of nature. 1101 MEDICAL'ARTs BUILDING
ANOMALY OF U P P E R RIGHT CENTRA~L INCISOR CASE REPORT
ADOLPH JUTKOWITZ,
B.S., D.D.S., a NEW YORK, N. Y.
H E case to be presented is of interest because it concerns an anomaly in the formation
T of the upper right central incisor.
The patient, W. G., a boy 9 years 2 months of age, presented himself for the correction of a malocclusion and because his upper right central incisor was not completely erupted. Figs. 1 and 2 show a photograph o f the teeth and casts of the case previous to starting treatment. I n fact, when the boy was first seen, only the two opposing corners of the tooth were visible, giving the appearance of two separate teeth erupting. The upper right lateral incisor was erupting to the lingual and it appeared as though it were a supernumerary tooth. X-rays were taken and it was found (Fig. 3) that the upper right central incisor had a very large crown made up of two parts which appeared fused for most of its length from the incisal to the gingival portions, with two separate roots and two separate pulp chambers and root canals. The upper right permanent lateral incisor and cuspid were present. The upper left permanent central incisor and lateral incisor were in lingual version. The history revealed nothing which could account for the anomaly. The boy's father seemed to think t h a t a fall which the boy had suffered when he was 21~ or 3 years of age might have been a contributing factor. This is disproved by the fact that the incisal half of the central incisor crown is calcified before that age is reached. I t was decided to first correct the positions of the upper left Central and lateral incisors. Bands were placed on the upper first permanent molars with horizontal buccal tubes into which a labial arch, 0.040 inch in diameter, was placed. By the time these teeth were put, into their correct positions, the anomalous central incisor had erupted completely. Since the tooth presented two separate pulp chambers and two separate roots it was decided to separate the two parts of the crown by cutting through the fused postion with carborundum disks. The mesial part of the tooth was to be brought mesialiy and was to ocdupy *Assistant Professor, Department of Orthodontics, New York University, College of Dentistry.
ANOMALY
OJs' U [ ' I ' E R RI(IIIT
F i g . 1.
Fig'.
2.
CENTRAL INCISOR
527
528
ADOLPH JUTKO~VITZ
Fig.
4.
F i g . 5.
Fig. 6
ANOMALY OF UPPER RIGHT CENTRAL INCISOR
529
the position of the right central incisor while tlle distal portion was to be extracted. Four months after beginning the orthodontic treatment this separation was done. The orthodontic treatment was continued as planned and the upper right lateral incisor was placed in its proper position. Fig. 4 is a photograph showing the mesial part of the central incisor in its proper position prior to extracting the distal portion. Fig. 5 is a photograph after the treatment was completed showing the upper lateral incisor in its correct position. lq'o attempt was made to move the right lateral incisor into position until the distal half of the central incisor was extracted.
Fig. 7. The mesial portion of the central incisor has maintained its vitality and at a suitable time will have a porcelain jacket crown placed on it to match the opposing tooth. Fig. 6 shows the casts at completion of treatment, and Fig. 7 shows the x-rays. The significant facts with regard to this case are: (1) some anomalous tooth forms can be so controlled as to make them, or portions of them, serviceable units of the dental arch; and (2) observation of cases during developmental periods make it possible to resort to relatively simple procedures for the prevention of complicated malocclusions. I wish to thank Dr. Hemley for his cooperation in planning the treatment for the patient.