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Congenitally absent mandibular right first premolar in which the maxillary right first premolar was extracted and spaces were closed
CONGENI'fALLY ABSENT MANDIBUI,AR RIGHT FIRST PREMOLAR IN WHICH THE MAXILLARY RIGHT FIRS'!' PREMOLAR WAS EXTRACTED AND SPACES WERE CLOSED·
By E. B.
ARNOLD,
D.D.S.,
HOUSTON, TE..'(AS
HISTORY
aged eleven years, weight 100 pounds, height 4 feet 7 inches. BOY,Feeding was natural until seven weeks old, then modified cow's milk was given. He has always eaten plenty of fruits and vegetables during his life. Adenoids and tonsils were removed at the age of ten. Diseases: Whooping cough at age three years. Measles with very high fever at age seven. Mumps at age eight. Chickenpox at age nine. Operated on for sinus trouble when ten years old.
Fig. 1.
The child had used a pacifier for five months. Father was average height, weight 160 pounds. Teeth fairly normal, neutroclusion. Mother was average height, had slightly crowded and protruding maxillary anterior teeth, neutroclusion. Oral examination of teeth revealed that they were of sound structure. Small occlusal fillings in the maxillary first permanent molars. Mandibular right second premolar not present. Radiographic examination of teeth revealed cavity in the mesial surface of the mandibular left permanent molar which was filled before treatment. Congenital absence of the mandibular right second premolar. -Read at the Thirtieth Annual Meeting of the American Soelety of Orthodontists, St. Louis, Mo., April 21-24, 1931.
742
Oongenitally Absent Mandibular' Right First Premolar
743
CLASSIFICATION
Cusps of the mandibular right and left first permanent molars and canines were distal in their relation to the maxillary teeth. The mandibular left first permanent molar was more distal than the right in its cusp relation to the maxillary, probably because of the mandibular right first permanent molar moving mesially in the absence of the mandibular right second premolar. The maxillary right first permanent molar was occluding lingually in its relation to the mandibular right first permanent molar. 'Ve classed this as a distoclusion type one. Fig. 1 shows right and left, and occlusal views of the case at the beginning of treatment, October, 1927. PLAN OF TREATMENT
Owing to the absence of the mandibular right second premolar, there were three plans of treatment to be considered: first, closing all spaces on the mandibular right side by moving the mandibular right molars forward
Fig. 2.
which would give a mesial cusp relation of the mandibular molars to the maxillary molars; second, opening of the space on the right where the second premolar was absent and the placing of an artificial restoration; third, extracting the maxillary right first premolar and moving the maxillary and mandibular right molars anteriorly which would give the patient normal anteroposterior cusp relation without artificial restoration. I decided that the latter plan of treatment would be best for the patient. APPLIANCES AND TREATMENT
Molar bands carrying 0.040 buccal tubes were constructed for the four first permanent molars. Bands with lingual spurs were constructed for the mandibular left second premolar and the mandibular right first premolar for rotating purposes. We decided first to correct the lingual occlusion of the maxillary right first permanent molar. This was accomplished by a maxillary lingual appliance which was attached to the maxillary left first permanent molar band
744
E. B. Arnold
with a half-round tube soldered parallel to the long axis of the tooth. On the right it was attached to the first permanent molar band with a round tube soldered at a right angle to the long axis of the tooth. The appliance was so constructed that it touched the left premolars but did not touch the right premolars. This reinforced the anchorage on the left side so that when
FIg. 3.
FIg. 4.
pressure was applied the right first permanent molar moved buccally to its normal buccolingual cusp relation to the mandibular right first permanent molar. This being accomplished an 0.038 labial appliance with intermaxillary hooks was inserted in the maxilla. The labial appliance was so adjusted as to expand the arch laterally and the stops were left away from the buccal tubes so that the maxillary anterior teeth could be retracted slightly. Later
Congenitally Absent Mandibular Right Eirst Premolar
745
the stop on the left side was adjusted against the buccal tube while the right side was left away from the tube. An 0.038 labial appliance was inserted in the mandible with the stop adjusted so that it did not touch the tube on the right side and that when the rubber ligatures were worn' the mandibular right molars were permitted to move forward. An 0.038 wire was used purposely so it would allow free
Fig. 5.
Fig. 6.
movement of the mandibular right molar, the buccal tube being 0,040. After the spaces on the mandibular right side were closed and the mandibular left side presented a normal anteroposterior cusp relation, the remaining spaces on the right of the maxilla were closed by the use of silk ligatures attached from a spur, soldered on the maxillary arch at the distal surface of the canine
region, to the distal surface of the right buccal tube.
746
E. B. Arnold
Congenitally Absent Mandibular Right First Premolar
747
Fig. 2 shows right and left and occlusal views of the case January, 1929, at which time all appliances were removed. Fig. 3, on the right, occluded views, March, 1931, two years and two months after all appliances were removed. On the left is the case before treatment. Fig. 4, at the right, shows the occlusal views two years and two months after treatment. At the left, the case . before treatment.
Fig. 8.
Fig. 9.
Fig. 5 shows intraoral x-ray pictures of the case at the beginning of treatment. Fig. 6 shows intraoral x-ray pictures of the case two years after all appliances were removed. Fig. 7 shows extraoral x-ray pictures of the case March, 1931. Fig. 8 shows right and left profile views of patient March, 1931. Fig. 9 shows photographs of anterior views of patient March, 1931.
By E. B.
ARNOLD,
D.D.S.,
HOUSTON, TE..'(AS
HISTORY
aged eleven years, weight 100 pounds, height 4 feet 7 inches. BOY,Feeding was natural until seven weeks old, then modified cow's milk was given. He has always eaten plenty of fruits and vegetables during his life. Adenoids and tonsils were removed at the age of ten. Diseases: Whooping cough at age three years. Measles with very high fever at age seven. Mumps at age eight. Chickenpox at age nine. Operated on for sinus trouble when ten years old.
Fig. 1.
The child had used a pacifier for five months. Father was average height, weight 160 pounds. Teeth fairly normal, neutroclusion. Mother was average height, had slightly crowded and protruding maxillary anterior teeth, neutroclusion. Oral examination of teeth revealed that they were of sound structure. Small occlusal fillings in the maxillary first permanent molars. Mandibular right second premolar not present. Radiographic examination of teeth revealed cavity in the mesial surface of the mandibular left permanent molar which was filled before treatment. Congenital absence of the mandibular right second premolar. -Read at the Thirtieth Annual Meeting of the American Soelety of Orthodontists, St. Louis, Mo., April 21-24, 1931.
742
Oongenitally Absent Mandibular' Right First Premolar
743
CLASSIFICATION
Cusps of the mandibular right and left first permanent molars and canines were distal in their relation to the maxillary teeth. The mandibular left first permanent molar was more distal than the right in its cusp relation to the maxillary, probably because of the mandibular right first permanent molar moving mesially in the absence of the mandibular right second premolar. The maxillary right first permanent molar was occluding lingually in its relation to the mandibular right first permanent molar. 'Ve classed this as a distoclusion type one. Fig. 1 shows right and left, and occlusal views of the case at the beginning of treatment, October, 1927. PLAN OF TREATMENT
Owing to the absence of the mandibular right second premolar, there were three plans of treatment to be considered: first, closing all spaces on the mandibular right side by moving the mandibular right molars forward
Fig. 2.
which would give a mesial cusp relation of the mandibular molars to the maxillary molars; second, opening of the space on the right where the second premolar was absent and the placing of an artificial restoration; third, extracting the maxillary right first premolar and moving the maxillary and mandibular right molars anteriorly which would give the patient normal anteroposterior cusp relation without artificial restoration. I decided that the latter plan of treatment would be best for the patient. APPLIANCES AND TREATMENT
Molar bands carrying 0.040 buccal tubes were constructed for the four first permanent molars. Bands with lingual spurs were constructed for the mandibular left second premolar and the mandibular right first premolar for rotating purposes. We decided first to correct the lingual occlusion of the maxillary right first permanent molar. This was accomplished by a maxillary lingual appliance which was attached to the maxillary left first permanent molar band
744
E. B. Arnold
with a half-round tube soldered parallel to the long axis of the tooth. On the right it was attached to the first permanent molar band with a round tube soldered at a right angle to the long axis of the tooth. The appliance was so constructed that it touched the left premolars but did not touch the right premolars. This reinforced the anchorage on the left side so that when
FIg. 3.
FIg. 4.
pressure was applied the right first permanent molar moved buccally to its normal buccolingual cusp relation to the mandibular right first permanent molar. This being accomplished an 0.038 labial appliance with intermaxillary hooks was inserted in the maxilla. The labial appliance was so adjusted as to expand the arch laterally and the stops were left away from the buccal tubes so that the maxillary anterior teeth could be retracted slightly. Later
Congenitally Absent Mandibular Right Eirst Premolar
745
the stop on the left side was adjusted against the buccal tube while the right side was left away from the tube. An 0.038 labial appliance was inserted in the mandible with the stop adjusted so that it did not touch the tube on the right side and that when the rubber ligatures were worn' the mandibular right molars were permitted to move forward. An 0.038 wire was used purposely so it would allow free
Fig. 5.
Fig. 6.
movement of the mandibular right molar, the buccal tube being 0,040. After the spaces on the mandibular right side were closed and the mandibular left side presented a normal anteroposterior cusp relation, the remaining spaces on the right of the maxilla were closed by the use of silk ligatures attached from a spur, soldered on the maxillary arch at the distal surface of the canine
region, to the distal surface of the right buccal tube.
746
E. B. Arnold
Congenitally Absent Mandibular Right First Premolar
747
Fig. 2 shows right and left and occlusal views of the case January, 1929, at which time all appliances were removed. Fig. 3, on the right, occluded views, March, 1931, two years and two months after all appliances were removed. On the left is the case before treatment. Fig. 4, at the right, shows the occlusal views two years and two months after treatment. At the left, the case . before treatment.
Fig. 8.
Fig. 9.
Fig. 5 shows intraoral x-ray pictures of the case at the beginning of treatment. Fig. 6 shows intraoral x-ray pictures of the case two years after all appliances were removed. Fig. 7 shows extraoral x-ray pictures of the case March, 1931. Fig. 8 shows right and left profile views of patient March, 1931. Fig. 9 shows photographs of anterior views of patient March, 1931.