Romanian Journal of Oral Rehabilitation Vol. 11, No. 1, January - March 2019

CONSIDERATIONS REGARDING ORTHODONTIC TREATMENT IN ADULT PATIENTS WITH EXTRACTION OF ECTOPIC CANINES

Mioara DECUSARĂ, Dorina-Cerasella ŞINCAR*, Cristian Constantin BUDACU , Oana CHIPIRLIU, Gabriela POPA, Gabriel-Valeriu POPA, Kamel EARAR

”Dunărea de Jos” University, Galaţi, Romania Faculty of Medicine and Pharmacy, Department of

* Corresponding author: e-mail: [email protected] [email protected]

Abstract Orthodontic treatment aims to give patients a more satisfactory dental and facial appearance and to improve the functions of the dentomaxillary apparatus. Orthodontic treatment is influenced by the pattern of facial growth, the development of dentition and occlusion, and the severity of the dento-maxillary abnormality. Patients often require orthodontic treatment for dental crowding, especially in the anterior dental area. Following the clinical examination and study models, the radiological examination (orthopantomogram and cephalography) and after establishing the orthodontic diagnosis and prognosis, the orthodontist may recommend performing dental extractions to achieve dental alignment and stable occlusal relationships, with maximum intercuspidation. Depending on the clinical situation and the severity of the dento-maxillary abnormality, is recommended extraction of the , the wisdom molars , the teeth affected by carious lesions, with large and irreparable coronary destruction. The indication of definitive canine extraction should be avoided in view of their coronadicular anatomy and the importance of facial aesthetics and mandibular functional movements. In this article we will present orthodontic treatment in one case of adult patient who have requested dental alignment and occlusal balancing after definitive canine extractions. The extractions were carried out in childhood by , dued to the canine vestibular ectopic position, the dental crowding, without subsequent orthodontic treatment. Key words: orthodontic treatment in adults, extraction of ectopic canines, dental alignment

Introduction. Extractions of the teeth are extractions.[2,3] Model analysis establishes made to provide space for the alignment of the degree of discrepancy between and crowded teeth, for the retraction of protruded tooth structure, the symmetry of the dental teeth or camouflaging the skeletal class II arches, the depth of the curve of Spee, the and class III . Evaluation of Bolton discrepancy. Cephalometric variables diagnostic elements for extraction will be sets the vertical facial proportions, facial done taking into account by genetic factors, paternal growth, direction and growth environmental influences, facial appearance potential of the , the facial rotation, and growth, model analysis and the position of lower . Depending on cephalometric variables.[1] Facial the variables obtained by various appearance is important for extraction or measurements, is established the skeletal non-extraction orthodontic therapy because diagnosis, the prognosis of dental the profile can be affect to the abnormalities, the orthodontic treatment detriment of the patient. In malocclusions planning and dental extraction decision. For with skeletal discrepancies is very important example, treatment geared toward achieving to establish if the patient is still undergoing facial balance is more likely to extract in significant facial growth; if the case can be skeletal open bite and not extract in cases corrected by growth redirection, the with skeletal deep bite.[2,4] The choice of orthodontist can treat it without individual teeth extraction depends on the

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Romanian Journal of Oral Rehabilitation Vol. 11, No. 1, January - March 2019 existing dental crowding, the odontal and molars extractions are: facilitation of first periodontal status or the ectopic position of distal movement, disimpaction of third the tooth / teeth proposed for extraction, the molars an faster eruption of them and pattern of individual growth and the prevention of "late" imbrications. harmonious soft-tissue profile. For example, [1,2] Permanent canines can be extracted in extraction of maxillary incisors for the following situations: when they are orthodontic treatment are indicated when the distroyed by caries, when are horizontally incisors are affected by grossly carious or are impacted, without the possibility of surgical- malformed that cannot be restored, are orthodontic recovery, when presentig suffered trauma or irreparable damage, are follicular , anklosed, with internal or impacted unfavorable, in case of buccally external root resorption. [3,7] The other or lingually blocked out lateral incisor with indications for definitive canine extraction good contact between central incisor and are: when they are ectopic (vestibular or canine or on congenitally missing one of palatinal), without space for alignment, away lateral incisor so opposite incisor may from the place of alignment, and when the require extraction to maintain arch orthodontic movements and forces during symmetry. [2,3] The extraction of orthodontic treatment necessary for the mandibular incisors are indicated on recovery of the canines can cause the root permanent dentition, with Class I molar resorption of the neighboring teeth with their relationship, with little or no crowding in avulsion. As far as possible, the removal of the maxillary arch, existing Bolton the definitive canines should be avoided discrepancy and minimal-to-moderate because is one of the most solid tooth in the overbite. Extraction of a lateral incisor is mouth and it can bear significant forces. Its generally preferred because it is less visible root is one of the longest among all the teeth, from the front; it is advisable to extract the including molars. Canines have a particular mandible incisors with periodontal functional role; they guide the mandibular conditions, with gingival recession, and with movements, and protects the other teeth by any restorations, including endodontic preventing them from being in contact with treatment. [2,5] Extraction of first premolars each other. [4,7] Canines have a significant is most often indicated in cases of dental esthetic role, because they are in the “corner” crowding, because increase anchorage, with of the mouth and they have a particular maximum lip retraction, asure better contact shape that ensures the transition between the between the canines and second premolars anterior and posterior teeth. In cases with and they are nearer to anterior crowding. cuspids extractions or if they are [1,6] The first molars are indicated to extract malpositioned in the dental arches, other when are extensively carious or hypoplastic , teeth will have to play the role of the canines with heavily filled and apical pathology or and this may cause short or long-term root canal treated and the premolars are problems (wears, periodontal recessions, jaw perfectly healthy and in cases with crowding joints problems, etc.) [8-22]. at the distal part of the arches and wisdom Taking into account the above we will teeth reasonably positioned and high present orthodontic treatment in one case of maxillary/mandibular planes angle with adult patient who have requested dental anterior open bite cases.[3,4] The second alignment and occlusal balancing after molars extractions are made when are extractions of definitive canine. The severely carious, ectopically erupted, or extractions were carried out in childhood by severely rotated, in cases with skeletal Class dentists, dued to the canine vestibular I malocclusions with arch length discrepancy ectopic position, the dental crowding, in the distal part of the arch or with mild without subsequent orthodontic treatment. anterior crowding and in Class II "skeletal" Clinical case presentation. Patient L.G., cases with only mild crowding of the female, 30 years, asked for consultation and mandibular arch. The advantages of second orthodontic treatment for alignment the

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Romanian Journal of Oral Rehabilitation Vol. 11, No. 1, January - March 2019 bimaxillary dental crowding, after consulting - the absence of 13 and 33 another orthodontist. The exo-oral clinical - bimaxillary dental crowding about 4 examination noted: mm, with rotations at 23 and mandibular - round and symetric facies incisors - the equal proportion of the figure - the presence of the four wisdom teeth floors - lack of correspondence between - normal convex profile median and inter-incisive lines - deviation to the right of the jaw - periodontal recession at the level of interliner line relative to the facial 34, due to occlusal trauma, the midline during the smile. mandibular performing The intraoral clinical examination revealed mandibular propulsion and left side (Fig.1): lateral guidance - odontal lesions treated with composite - neutral bilateral molars relations fillings at 14 and 46 - anterior overbite about 1/2 - central maxillary incisors with - the curve of Spee deep, on both side atypical shape, in the trapezium, with an incisive sum of 34 mm

Fig. 1 Appearance of dental arches at the beginning of orthodontic treatment

The patient said that around 13 years of age, The examination of the orthopantomogram extraction of canines 13 and 33 was reveals (Fig.2): performed on request dued to vestibular - endodontic treatment at the 14 ectopic eruption without space for alignment. - the absence of 13 and 33 The extractions were performed by a - the mandibular anterior rotation without asking for orthodontic consultation, (upward ascending ramus, considering that extracting ectopic canines mandibular condyles with anterior will resolve the existing dental crowding. orientation)

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Romanian Journal of Oral Rehabilitation Vol. 11, No. 1, January - March 2019

Fig.2 The orthopantogram of the L.G. patient at the beginning of orthodontic treatment

The examination of the model casts revealed The treatment was performed with a fixed a maxillary dental crowding of 3 mm and a metallic orthodontic appliance, applied mandibular of 6 mm. The proposed bimaxillary; after 21 months the appliance orthodontic treatment plan was: was removed and for contention were used - the orthodontic extraction of 44 and polyester retainers wearing at night.As can 24, for occlusal balancing and be seen in (Fig.3), the orthodontic treatment obtaining the correspondence of the achieved the patient's objective, namely the median and inter-incisive lines. The bimaxillary dental alignment. It also patient initially refused any maintained the bilateral neutral relationship extraction, finally accepting the at the molars and the deviation of the upper extraction of 44. median line to the right (dued to the - leveling and alignment of dental extraction of 13) and to the lower median arches line to the left (dued to its extraction 33), a - closure of the mandible extraction false correlation of the inter-incisive lines, space anterior overbite of 1/2, with the leveling of - leveling the Spee curve, achieving the Spee curve. the 1/3 anterior overbite.

Fig. 3 Appearance of dental arches at the end of orthodontic treatment Conclusions Dental extractions in crowding and only after establishing a are performed to solve dental correct diagnosis and a correct treatment

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Romanian Journal of Oral Rehabilitation Vol. 11, No. 1, January - March 2019 plan. Extraction of definitive canines is guidance impossible and may compromise a rarely recommended due to its functional good functional occlusal result. Contact role in guiding the mandible and protecting between a premolar and a lateral incisor is the neighboring teeth, but also its aesthetic often poor and canines can act as ideal role with its particular shape, ensuring the abutment teeth because of their long root transition between the anterior and posterior length and resistance to periodontal teeth. The loss of a canine makes canine problems [8,9]. References:

1. Graber TM:Principles and Practice Orthodontics,WB Saunders,1988 2. Proffit W. R. Contemporary orthodontics , Mosby, 2007. 3. Canal P., Salvadori A. Orthodontie de l’adulte, Ed.Elsevier Masson, 2008. 4. Melsen Birte- Adult orthodontics, BlackWell Publishing Ltd., 2012 5. Canut JA. Mandibular incisor extraction: indications and long-term evaluation. Eur J Orthod 1986; 18: 485– 489. 6. Berg R, Gebauer U. Spontaneous changes in the mandibular arch following first premolar extractions. Eur J Orthod 1982; 4: 93–98. 7. Decusară Mioara- Utilizarea ortopantomogramei în practica stomatologică , Ed. Zigotto, 2017, Galați, ISBN : 978-606-669-263-2. 8. Mioara Decusară, Cerasella-Dorina Șincar, Gabriel-Valeriu Popa – Considerații privind particularitățile tratamentului ortodontic la adulți , Revista Română de Stomatologie, 2018, 64(2): 115-118. ISSN : 1843- 0805 2069-6078. 9. Mioara Decusară, Dorina-Cerasella Șincar, Magdalena Rusu, Alexandru Mircea Nicolau –Therapeutical considerations on the orthodontic preprosthetic treatment, Analele Universității ”Dunărea de Jos” Medicină, 2016, XVII(2):13-16, ISSN: 2344-4428. 10. Antohe ME, Forna Agop D., Dascalu CG, Implications of digital image processing in the paraclinical assessment of the partially edentated patient, Revista de Chimie, 69(2),2018 pg.521-524 11. Niculescu,O.,Nica,P., Gurlui,S.,et al., Experimental investigations of polymer plasma laser ablation, Materiale Plasice, 46(3), 2009, pg.336-338 12. Vasluianu, E., Popescu,V., Grigoriu,A., et al., Comparative study concening the FIR Analysis and the performances of chitosan –based wrinkle-proofing agents, Revista de Chimie, 64(10), 2013, pg.1104-1115 13. Nash,D.,Ruotoistenmaki,J., Argentieri,A.et al.,Profil of the oral healhcare team in countries with emerging economies,Conference Global Congress on Dental Education location,Dublin,Ireland, European Journal of Dental Education,12((1), 2008, pg.111-119 14. Popescu,V., Vasluianu,E., Forna,N.C., et al., Comparative study of the FTIR Analysis and the peformances of N,N,N-trimethyl chitosan as wrinke-poofing agent, Revista de Chimie,4(11),2013, pg.1284-1294 15. Botnariu,G., Forna, N., Popa,A., et al., Correlation of glycemic control parameters in non-diabetic pesons with cardiovascular risk scores-results from a cross-sectional study, 8(1),2017, pg.108-110 16. Iliescu-Bulgaru,D., Costea,G., Scripcaru,A., et al., Homicide and alcohol consumption.A medico-legal and psychiatric interdisciplinary appoach.Multivariate analysis,Romanian Journal of legal medicine, 23(2),2015, pg.137-142 17. Ifteni,G., Apostu,A., Tanculescu,O., Dental occlusion and the importance of is proper investigation-partII, Romanian Journal of Oral Rehabilitation, 8(4),2016,pg.17-22 18. Golovcenco,L., Scripcaru,C., Zegan, G., Thid molar development in relation to chronological age in Romanian childen and young adults,Romanian Journal o legal medicine,17(4), 2009, pg.277-282 19. Jumanca D., Galuscan,A., Podariu,A.C., et al.,Anti-inflammatory action of oothpastes conaining betulin nanocapsules, Revista de Chimie,65(12),2014,pg.1473-1476 20. Balan G., Grigore, C.A., Budacu,C.C., et al., Antisepsis, Desinfection Sterilization -mehods used in dentistry, Revista de chimie, 68(1), 2017, pg.186-191 21. Zegan, G., Dascalu, C.G., Mavru, R.B., Cephalometric, features of Class III , Medical-surgical journal,119(4), ,2015, 1153-1160; 22. Matei ,M.N., Chiscop, I, Earar K., et al., Evaluation of corrosion resistance of NiTi Nb orthodontic wires in tomato juice, Revista de Chimie, 66(12),2015, pg.2009-2012

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