Natural reversal of tooth discoloration and pulpal response to testing following removal of a miniscrew implant for orthodontic anchorage: a case report

Abstract

A 23-year-old woman presented with a class III malocclusion, with crowded and malformed teeth and excessive gingival display. During orthodontic treatment, a Tomas orthodontic miniscrew was placed between the root apices of the maxillary central incisors. This was carried out by an orthodontic specialist who had treated more than 700 patients (with more than 2000 mini-implants) over the past 9 years. After 2 weeks of treatment, the right maxillary central incisor discoloured and did not respond to electrical pulp tests (EPT) but was sensitive to endo-ice. The miniscrew was removed under local anaesthesia. Teeth 11 and 21 were fixed with ligation wire, and glass-ionomer cement (GIC) was added to the occlusal surfaces of the first and second maxillary molars to heighten the occlusion and disclude the maxillary anterior teeth. After 4 months, the colour and pulp reactions to EPT and endo-ice of tooth 11 returned to normal. Because the use of a miniscrew had appeared to damage the pulp, subsequent a conservative orthodontic treatment using, traditional 'J' hooks was used and achieved satisfactory results. After 23 months of orthodontic treatment, the treatment was complete and a 15-month follow-up showed a successful outcome.

Complications reported with the use of orthodontic miniscrews: A systematic review

“…All studies reported side effects and complications associated with the use of orthodontic miniscrews. The studies, as summarized in Figure 2 , were identified as follows: 11 case reports, 13 - 23 8 retrospective longitudinal studies, 24 - 31 3 prospective controlled trials, 32 - 34 1 preliminary study, 35 and 1 case series. 36 All studies were conducted in a university setting and included both male and female participants.…”

“…All the miniscrews were surgically inserted according to the protocol suggested by the respective manufacturer. According to each orthodontic treatment plan, the miniscrews were positioned both in the maxilla and in the mandible, in the interradicular area, 13 , 15 , 18 , 19 , 21 - 24 , 32 , 33 , 36 palatal zone, 16 , 17 , 25 , 26 , 31 infrazygomatic crest, 28 , 36 ascending ramus, 26 or buccal shelf. 20 , 26 , 29 …”

“…Seven studies reported root perforation, 18 , 19 , 21 , 23 with an associated periradicular lesion, 16 loss of tooth vitality, 27 pink discoloration of the crown, and transitory loss of vitality. 22 Three studies reported contact of the miniscrew with the root of the adjacent tooth. 21 , 33 , 34 Three studies also reported the perforation of the maxillary sinus, 28 , 32 , 36 and one study reported the perforation of the nasal cavity floor.…”

Risk factors and diagnosis of iatrogenic damage of periodontal structures and roots during orthodontic Mini-Implants implantation procedures - a systematic literature review

“…Częstość występowania kontaktu MI z korzeniem ocenia się na 20% [7], natomiast według Fabbroni i wsp., kontakt występował w nieznacznie większym odsetku pacjentów-27.1% [8]. Potencjalnymi efektami urazu ozębnej i/lub korzenia mogą być: utrata żywotności miazgi, osteoskleroza, ankyloza [9] oraz resorpcja zewnętrzna korzenia [10]. Według Rodriguez i wsp.…”