Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer

Abstract

This article describes the orthodontic relapse with mandibular incisor fenestration in a 36-year-old man who had undergone orthodontic treatment 21 years previously. The patient reported that his mandibular 3 × 3 bonded retainer had been partially debonded and broken 4 years earlier. The mandibular left lateral incisor remained bonded to the retainer and received the entire load of the incisors; consequently, there was extreme labial movement of the root, resulting in dental avulsion. As part of the treatment, the root was repositioned lingually using a titanium-molybdenum segmented archwire for 8 months, followed by endodontic treatment, an apicoectomy, and 4 months of alignment and leveling of both arches. The treatment outcomes were excellent, and the tooth remained stable, with good integrity of the mesial, distal, and lingual alveolar bones and periodontal ligament. The 1-year follow-up showed good stability of the results.

Single tooth torque correction in the lower frontal area by a completely customized lingual appliance

“…So far there are only case reports in the present literature describing the periodontal changes after orthodontic single tooth correction. Our results accord with these case reports, which also reported a significant improvement of the periodontal situation due to orthodontic treatment [ 9 , 12 ]. All these cases showed a massive gingival recession on the tooth with the torque problem before treatment.…”

“…The teeth rotate around the retention wire either to the buccal or lingual site. There are some studies reporting about undesirable tooth movements due to a broken retainer [ 8 , 9 ]. These tooth movements can result into a relapse similar to the situation before orthodontic treatment or into a new malocclusion [ 10 , 11 ].…”

“…Different techniques are described in these case reports. Some authors use the technique with segmented archwires, some prefer the technique with continuous archwires [ 9 , 12 ]. The challenge is to move only the one tooth while not affecting the neighboring teeth, because they are in the correct position.…”

Development of a clinical practice guideline for orthodontic retention

“…[34][35][36] Bonded retainers can become unintentionally active due to the properties of the wire material, elastic deflection during insertion and repair, mechanical deflection caused by chewing forces and parafunctions. 33,35,[37][38][39][40][41][42] Although the incidence of this phenomenon is low, it is highly problematic, since the consequences can be dramatic if unnoticed. [39][40][41] The use of rectangular and square wires will decrease the incidence of unintentionally active retainers.…”

“…33,35,[37][38][39][40][41][42] Although the incidence of this phenomenon is low, it is highly problematic, since the consequences can be dramatic if unnoticed. [39][40][41] The use of rectangular and square wires will decrease the incidence of unintentionally active retainers. 5,33…”