Case Report
Difficult Traction in Permanent Teeth with Eruption Disorders : Diagnosis and Treatment Methods
2022 Volume 60 Issue 2 Pages 62-73
Details
2022 Volume 60 Issue 2 Pages 62-73
Cases of abnormal eruption of permanent teeth are occasionally encountered in pediatric clinical dentistry. In many cases, eruption can be promoted by appropriate and timely interventions. However, in some cases, treatment is difficult and/or eruption cannot be achieved. This study assessed the time courses of treatment in two groups of subjects, and the pre-treatment test findings were compared between them.
Each group included four subjects and the groups were defined as follows : the “favorable group,” in which guided eruption was possible using the standard method, and the “unfavorable/refractory group,” in which ankylosis was suspected and traction was difficult or impossible. The study findings were as follows :
1. Ankylosis is suspected if preoperative radiography shows an unclear image of the periodontal ligament of the diseased tooth. Three-dimensional examination by CBCT is effective in such cases.
2. Despite the absence of obstacles to clear eruption, ankylosis is suspected if a part of the tooth crown is exposed at the gingival margin, and if tooth eruption has stopped.
3. Using detailed interviews, patients' dental history is obtained to determine whether they had experienced conditions that could have damaged the periodontal ligament of the diseased tooth, such as injury to the diseased tooth or injury to or extraction of the supernumerary teeth from the neighboring region. If deemed appropriate, consideration is given to whether these factors could complicate guided eruption.
4. The generally known characteristics of ankylosed teeth―change in percussion sound and loss of physiologic mobility―are difficult to detect at the early stages of ankylosis.
If guided eruption is expected to be difficult, it is crucial to select the optimal treatment method and also assess the invasiveness and effectiveness sufficiently. Furthermore, clinically, it is critical to provide full explanations to pediatric patients and their guardians about how treatment results cannot be reliably expected, and about the subsequent approaches that are necessary; this information should be shared with them as appropriate.
