IADR Abstract Archives
Comparative Orthodontic Extraction Space Closure With and Without Socket Preservation
Objectives: To present a compromised orthodontic-periodontal condition of both mandibular first molars extracted prior to orthodontic tooth movement (OTM). A comparative assessment of orthodontic extraction space closure in posterior mandibular segment with and without HA-β-TCP (4Bone®) bone graft material is demonstrated.
Methods: A healthy 13-year-old male patient with skeletal Class II pattern, bilateral mandibular canines and second molars impaction, and large caries lesions on both mandibular first molars was evaluated prior to orthodontic treatment. Both mandibular first molars were evaluated hopeless and extracted. A socket preservation using HA-β-TCP graft was performed only for the left mandibular first molar to induce the left mandibular second molar's eruption into the extraction space. Orthodontic treatment was performed aiming to close the extractions spaces, and achieving a stable occlusion and improved facial appearance.
Results: Impacted mandibular canines were successfully aligned, right molar extraction space was completely closed by the second molar mesialization process, right third mandibular molar spontaneously erupted and orthodontically aligned in a Class I relationship. However, on the left side, a 3 mm residual space remained unclosed in the grafted alveolar site. A surgical-periodontal tunneling procedure in the HA-β-TCP grafted site was performed in an attempt to overcome the grafted material obstacle along with the continued mesialized orthodontic forces, but did not succeed. The left second molar did not fully align leaving a molar open bite relationship and root resorption. However, final superimposition of pre- and post-treatment cephalograms revealed an improved facial profile, skeletal, dental and soft tissue relationships compared to the patient's preliminary records.
Conclusions: Pre-orthodontic HA-β-TCP graft in the alveolar ridge hindered OTM and may serve as a significant obstacle for orthodontic extraction space closure process.
Methods: A healthy 13-year-old male patient with skeletal Class II pattern, bilateral mandibular canines and second molars impaction, and large caries lesions on both mandibular first molars was evaluated prior to orthodontic treatment. Both mandibular first molars were evaluated hopeless and extracted. A socket preservation using HA-β-TCP graft was performed only for the left mandibular first molar to induce the left mandibular second molar's eruption into the extraction space. Orthodontic treatment was performed aiming to close the extractions spaces, and achieving a stable occlusion and improved facial appearance.
Results: Impacted mandibular canines were successfully aligned, right molar extraction space was completely closed by the second molar mesialization process, right third mandibular molar spontaneously erupted and orthodontically aligned in a Class I relationship. However, on the left side, a 3 mm residual space remained unclosed in the grafted alveolar site. A surgical-periodontal tunneling procedure in the HA-β-TCP grafted site was performed in an attempt to overcome the grafted material obstacle along with the continued mesialized orthodontic forces, but did not succeed. The left second molar did not fully align leaving a molar open bite relationship and root resorption. However, final superimposition of pre- and post-treatment cephalograms revealed an improved facial profile, skeletal, dental and soft tissue relationships compared to the patient's preliminary records.
Conclusions: Pre-orthodontic HA-β-TCP graft in the alveolar ridge hindered OTM and may serve as a significant obstacle for orthodontic extraction space closure process.