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An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up.

Cortes AR, No-Cortes J, Cavalcanti MG, Arita ES - Imaging Sci Dent (2014)

Bottom Line: The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst.An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts.CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Radiology, School of Dentistry, University of São Paulo, São Paulo, Brazil.

ABSTRACT
One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

No MeSH data available.


Related in: MedlinePlus

A clinical photograph shows the lower third molar before (A) and after (B) orthodontic extrusion.
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Figure 2: A clinical photograph shows the lower third molar before (A) and after (B) orthodontic extrusion.

Mentions: Thus, an orthodontic miniscrew (8 mm in length and 1.5 mm in diameter; Morelli, São Paulo, Brazil) was inserted into the buccal cortex between the first and second antagonist maxillary molars. Elastic traction was applied between the miniscrew and the orthodontic hook installed on the LTM occlusal surface with two orthodontic elastics. During the first week, the miniscrew orthodontic anchorage was applied. The patient reported a light "pins and needles" sensation in part of the tongue, lasting 3 days. At 3 weeks after miniscrew installation, the LTM was extruded markedly (Fig. 2), confirmed by CBCT coronal panoramic (Fig. 3) and cross-sectional follow-up images (Fig. 4). At this time, the LTM was surgically extracted. The roots did not fracture, and the LTM was easily removed from the alveolar socket. During surgery, there was no excessive bleeding or pain. No IAN damage or exposure was clinically observed. The root curvature, found to be in contact with the mandibular canal, was observed by examining the LTM after it was extracted and cleaned (Fig. 5). The patient's postoperative recovery was uneventful. The patient stated no significant discomfort during the LTM extrusion period, or during the extraction surgery. Additionally, no adjacent mandibular second molar loosening or displacement was observed during the entire treatment time. No postoperative complications were observed in a follow-up period of 28 months.


An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up.

Cortes AR, No-Cortes J, Cavalcanti MG, Arita ES - Imaging Sci Dent (2014)

A clinical photograph shows the lower third molar before (A) and after (B) orthodontic extrusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061303&req=5

Figure 2: A clinical photograph shows the lower third molar before (A) and after (B) orthodontic extrusion.
Mentions: Thus, an orthodontic miniscrew (8 mm in length and 1.5 mm in diameter; Morelli, São Paulo, Brazil) was inserted into the buccal cortex between the first and second antagonist maxillary molars. Elastic traction was applied between the miniscrew and the orthodontic hook installed on the LTM occlusal surface with two orthodontic elastics. During the first week, the miniscrew orthodontic anchorage was applied. The patient reported a light "pins and needles" sensation in part of the tongue, lasting 3 days. At 3 weeks after miniscrew installation, the LTM was extruded markedly (Fig. 2), confirmed by CBCT coronal panoramic (Fig. 3) and cross-sectional follow-up images (Fig. 4). At this time, the LTM was surgically extracted. The roots did not fracture, and the LTM was easily removed from the alveolar socket. During surgery, there was no excessive bleeding or pain. No IAN damage or exposure was clinically observed. The root curvature, found to be in contact with the mandibular canal, was observed by examining the LTM after it was extracted and cleaned (Fig. 5). The patient's postoperative recovery was uneventful. The patient stated no significant discomfort during the LTM extrusion period, or during the extraction surgery. Additionally, no adjacent mandibular second molar loosening or displacement was observed during the entire treatment time. No postoperative complications were observed in a follow-up period of 28 months.

Bottom Line: The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst.An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts.CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral Radiology, School of Dentistry, University of São Paulo, São Paulo, Brazil.

ABSTRACT
One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

No MeSH data available.


Related in: MedlinePlus