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Neutroclusion case involving congenitally absent teeth
NEUTROCLUSION
CASE
INVOLVING
CONGENITALLY
ABSENT
TEETH WALTER
J. SLY, D.M.D.,
BOSTON, &IASS.
T
HE patient, a girl twelve years of age, was presented for the purpose of improving the esthetics of the maxillary incisors, the principal objection of the parents being a wide diastema between the central incisors. Examination revealed a condition of neutroclusion with -212 and $$ congenitally absent. The maxillary right side was in linguoversion from -3) to 71 with 51 I_ unerupted and lying horizontally in the palatal. The VjV were inpositio< but the roots were nearly resorbed; p was rotated ancl standing labial to 13. History.-The history was that of the average normal healthy child with the exception of the missin g teeth. A younger sister also had missing lateral incisors but all her premolars were present. Etiology.-It is probable that loss of continuity of the approximal COILtacts due to the missing 212 is responsible for the collapse of the maxillary arch as well as for the cliaxt,ema between the incisors; 51 was retarded in development and eruption, which allowed 61 and 41 to closerhe space partial&. Disharmony of the arches was further inc~easedby the excess width in VIV.
Prognosis.-It is sometimes advisable in cases which involve missing lateral incisors, to redistribute the spaces without inserting supplies. Tn this case, however. the collapse of the maxillary arch makes it necessary to restore the space and to insert artificial substitutes. Some consideration was given to closing the VIV spaces, but after the maxillary right section was corrected this too was deemed inadvisable. Prognosis depends upon the establishment and maintenance of harmonious arch form by supplying the missing teeth and establishing vigorous function and correct cusp relation to prevent collapse of the arch 011 the right side. Trcatnzent.-The case was treated in the following manner : 3 and 15 were not loose but were so far resorbed that they were extracted before treatment was started. Xolar bands and lingual wire were applied to both maxillary am1 mandibular arches. The maxillary teeth in linguoversion 71 - to 31 were stepped over one at a time usin g U-shaped finger-springs, and the &sterna between 11 and 11 was closed by means of loop springs. The arch was then readapted to the-new form, and steel facings were soldered to the wire to maintain the lateral spaces and to improve the esthetics during the remaining treatment. Space for 51 was opened by means of the loop and a stop to 4); 51 was exposed surgically and a pin cemented into the occlusal fissure. It Presented at the Thirty-Fifth Chicago, April, 1937.
Annual
Merting 151
of the American
society of Orthodontists,
152
Walter
Fig.
Fig.
Fig. L-Casts Z.-Photographs
J. Sly
1.
before and after treatment. before and after treatment.
Neutroclusion
Case Involving
Fig. Fig.
3.-Showing
IF
Fig.
4.-Showing
51 horizontal
Fig.
loop
Fig. 5.-Diastcms Fig. B.--Appliance and stop to open
root
Congenitally
Absent Teeth
4.
absorption. and
q
with
roots
absorbed.
5.
of missing lateral after reconstruction space.
Fig. incisors. : lateral
facings
; rotation
6 of
3J:
unerupted
154
Walter
J. Sly
was then tipped buccally into alignment by means of a spring. Rotations were done as indicated, and the muscles of mastication were given suitable exercises. The maxillary arch was retained by means of a -414 retainer with the facings attached, and extensions to the 616. The mandibular arch was retained inaimilar manner with cast sanitary supplies to retain 515 spaces, and furnish occlusion with the maxillary arch. This case is presented principally illustrate the several complications from a single etiologic factor and also e simplicity of the appliances used. 60 CHARLESGATE
WEST
CASE
INVOLVING
CONGENITALLY
ABSENT
TEETH WALTER
J. SLY, D.M.D.,
BOSTON, &IASS.
T
HE patient, a girl twelve years of age, was presented for the purpose of improving the esthetics of the maxillary incisors, the principal objection of the parents being a wide diastema between the central incisors. Examination revealed a condition of neutroclusion with -212 and $$ congenitally absent. The maxillary right side was in linguoversion from -3) to 71 with 51 I_ unerupted and lying horizontally in the palatal. The VjV were inpositio< but the roots were nearly resorbed; p was rotated ancl standing labial to 13. History.-The history was that of the average normal healthy child with the exception of the missin g teeth. A younger sister also had missing lateral incisors but all her premolars were present. Etiology.-It is probable that loss of continuity of the approximal COILtacts due to the missing 212 is responsible for the collapse of the maxillary arch as well as for the cliaxt,ema between the incisors; 51 was retarded in development and eruption, which allowed 61 and 41 to closerhe space partial&. Disharmony of the arches was further inc~easedby the excess width in VIV.
Prognosis.-It is sometimes advisable in cases which involve missing lateral incisors, to redistribute the spaces without inserting supplies. Tn this case, however. the collapse of the maxillary arch makes it necessary to restore the space and to insert artificial substitutes. Some consideration was given to closing the VIV spaces, but after the maxillary right section was corrected this too was deemed inadvisable. Prognosis depends upon the establishment and maintenance of harmonious arch form by supplying the missing teeth and establishing vigorous function and correct cusp relation to prevent collapse of the arch 011 the right side. Trcatnzent.-The case was treated in the following manner : 3 and 15 were not loose but were so far resorbed that they were extracted before treatment was started. Xolar bands and lingual wire were applied to both maxillary am1 mandibular arches. The maxillary teeth in linguoversion 71 - to 31 were stepped over one at a time usin g U-shaped finger-springs, and the &sterna between 11 and 11 was closed by means of loop springs. The arch was then readapted to the-new form, and steel facings were soldered to the wire to maintain the lateral spaces and to improve the esthetics during the remaining treatment. Space for 51 was opened by means of the loop and a stop to 4); 51 was exposed surgically and a pin cemented into the occlusal fissure. It Presented at the Thirty-Fifth Chicago, April, 1937.
Annual
Merting 151
of the American
society of Orthodontists,
152
Walter
Fig.
Fig.
Fig. L-Casts Z.-Photographs
J. Sly
1.
before and after treatment. before and after treatment.
Neutroclusion
Case Involving
Fig. Fig.
3.-Showing
IF
Fig.
4.-Showing
51 horizontal
Fig.
loop
Fig. 5.-Diastcms Fig. B.--Appliance and stop to open
root
Congenitally
Absent Teeth
4.
absorption. and
q
with
roots
absorbed.
5.
of missing lateral after reconstruction space.
Fig. incisors. : lateral
facings
; rotation
6 of
3J:
unerupted
154
Walter
J. Sly
was then tipped buccally into alignment by means of a spring. Rotations were done as indicated, and the muscles of mastication were given suitable exercises. The maxillary arch was retained by means of a -414 retainer with the facings attached, and extensions to the 616. The mandibular arch was retained inaimilar manner with cast sanitary supplies to retain 515 spaces, and furnish occlusion with the maxillary arch. This case is presented principally illustrate the several complications from a single etiologic factor and also e simplicity of the appliances used. 60 CHARLESGATE
WEST