Échec de la mise en place de dents retenues et incluses

Abstract

<jats:p>La mise en place d’une dent incluse ou retenue, que ce soit chez l’enfant ou l’adulte, est un véritable défi pour le duo de praticiens que sont l’orthodontiste et le praticien en charge de la chirurgie de dégagement. La canine maxillaire est la dent la plus souvent incluse dans le secteur antérieur, avec une prévalence de 2 % dans la population générale. On comprend donc le défi fonctionnel et esthétique de la thérapeutique chirurgico-orthodontique dont l’objectif sera de mettre en place la dent incluse ou retenue sur l’arcade. De nombreuses erreurs devront être évitées pour obtenir un résultat satisfaisant, tant pour le patient que pour son praticien. C’est en faisant un diagnostic précis de la localisation de la dent, grâce à des techniques d’imagerie modernes, que nous pourrons réaliser un acte chirurgical respectueux de la dent concernée et des structures anatomiques qui l’entourent. Les axes et les forces de tractions seront également pensés et réfléchis afin de déplacer la dent jusqu’à sa position finale sur l’arcade dans des conditions optimales. Le contexte parodontal sera optimisé et contrôlé à chaque étape de la prise en charge. En effet, le but étant d’aller au devant de l’apparition des défauts parodontaux, sachant qu’il est plus difficile de tenter leur réparation. </jats:p>

Orthodontic traction of impacted canines: Concepts and clinical application

“…Therefore, good tomographic images are fundamental to a successful traction, for they allow professionals to accurately identify and locate the position of the impacted tooth, evaluate possible injuries to adjacent roots and to quantify the bone around each tooth. It also helps in detecting the existence of possible ankylosis in the roots of such teeth, 24 which could be interpreted as the most probable cause for them failing to reach the expected position during the eruptive movement. The visualization of these ankylosed zones may help professionals to choose a different treatment protocol, if compared to the conventional surgical exposure followed by orthodontic traction.…”

“…The risk of failing to pull the impacted tooth due to dental ankylosis should never be overlooked 24 . In addition, CT scan indicated an intimate relationship of tooth #13 with its neighbours, including signs of root resorption on tooth #14, which could hamper or prevent this movement.…”

Manejo multidisciplinario de canino superior retenido en vestibular con técnica VISTA y alternativas ortodóncicas. Revisión exploratoria apoyada en casos

“…Canines are essential teeth in dental arches due to their role in dynamic occlusion patterns and their importance for dentogingival esthetics and facial harmony (1). Canines are considered retained when, in certain cases, even with their eruption potential, local, physiological or pathological factors delay or prevent their eruption, despite having space available to locate them (2). Multiple factors are considered responsible for canine retention.…”

“…is prevents that, when erupting, the canine is devoid of keratinized gingiva or is le with fenestrations and dehiscence. (2) Depending on the mucogingival junction position, several surgical techniques have traditionally been used to access the canine, such as gingivectomy, repositioned ap, apically and/or laterally displaced aps, and more recently, a technique based on vestibular incision subperiosteal tunnel access (VISTA) that involves making an access or vertical incision from the mucogingival junction, in the maxillary anterior area, followed by the elevation of a subperiosteal tunnel, which was described by Zadeh in 2011 (8) for the treatment of recession-type mucogingival deformities. Each of the cases described in this study shows in detail the surgical procedures that this technique includes.…”