Read on to learn about a case that reflects an innovative approach to orthodontic treatment after trauma. This case sheds light on the challenges, treatment methods and results achieved, which can provide valuable insight for professionals and hope for patients in similar situations.
First attempts to help
The patient, a nine-year-old girl, suffered injuries to her facial region as a result of an unfortunate dog attack. The incident resulted in two damaged upper ones and stunted growth of the upper dental arch. During a free dental examination carried out as part of the Foundation's activities in one of the primary schools in Podlasie, Dr Barbara Obłoj, not having a fully detailed picture of the situation, referred the 10-and-a-half-year-old patient for urgent orthodontic treatment, issuing an appropriate written referral to her parents.
The patient, accompanied by her parents, reported to Dr Obloj after six months. The patient's mother reported that after the accident, the parents treated the child's two upper ones with root canal treatment in Siedlce. The doctor who carried out this treatment only dealt with the left upper one, while the right one was only observed.
Comprehensive assessment and treatment decisions
Unfortunately, due to extensive damage and root resorption, both the ones needed to be removed. Due to the child's ongoing bone growth process, it was not possible to place dental implants in place of the removed ones in the 11-year-old. Dr Obloj, given the need to remove the two upper permanent ones, the stunted growth of the upper dental arch and the present anterior overbite (i.e. a tendency to push the mandible forward, which posed a serious risk of the need for surgery at a later age), determined the optimal treatment plan.
The main objective was to try to avoid Le Fort I orthognathic surgery and sagittal osteotomy of the mandible in a patient aged 19 years, after her growth had been completed, which would have involved protrusion of the maxilla and retraction of the mandible. It was also important to avoid leaving the child without upper ones for approximately seven years.
Treatment plan
- Baseline of the patient's malocclusion:
2. Two permanent lower fifths were removed and fifths were grafted in place of the removed upper fifths (autotransplantation).
3. 8 months after transplantation of the lower fifths, upper fixed braces were fitted in place of the upper ones, as well as quadhelix braces to widen the upper dental gap; in another month, lower fixed braces were fitted.
4. 8 months after transplantation of the lower fifths, upper fixed braces were fitted in place of the upper ones, as well as quadhelix braces to widen the upper dental gap; in another month, lower fixed braces were fitted.
5. the crowns of the lower fives were reshaped to reshape the upper ones.
6. Continued planned orthodontic treatment with fixed braces - teeth were serialised.
7. upper and lower fixed braces were removed.
8. retained teeth removed: 18,28,38,48 (upper and lower eights).
The entire treatment lasted about 3.5 years.
