E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ ·fi ÙÔ˘˜
Ï·Á›Ô˘˜: ∑ËÙ‹Ì·Ù· ˘fi Û˘˙‹ÙËÛË
Ashok Kumar Jena,1 Satinder Pal Singh,2 Ashok Utreja3
1
∂›ÎÔ˘ÚÔ˜ ∫·ıËÁËÙ‹˜, Unit of Orthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India.
2
∂ÈÚfiÛıÂÙÔ˜ ∫·ıËÁËÙ‹˜, Unit of Orthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India.
3
∫·ıËÁËÙ‹˜ Î·È ¢È¢ı˘ÓÙ‹˜, Unit of Orthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and
Research, Chandigarh, India.
Orthodontic replacement of maxillary central incisors by lateral
incisors: Issues to be considered
Ashok Kumar Jena,1 Satinder Pal Singh,2 Ashok Utreja3
1
Asst. Professor, Unit of Orthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research,
Chandigarh, India.
2
Addl. Professor, Unit of Orthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research,
Chandigarh, India.
3
Professor and Head, Unit of Orthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research,
Chandigarh, India.
¶EPI§HæH
∆· ÂÚÈÛÙ·ÙÈο ÂÍ·ÁˆÁÒÓ ÂÓfi˜ ‹ ‰‡Ô ¿Óˆ ÎÂÓÙÚÈÎÒÓ
ÙÔ̤ˆÓ Â›Ó·È Û¿ÓÈ· ÛÙËÓ ÔÚıÔ‰ÔÓÙÈ΋. ªÂٷ͇ ÙˆÓ
¿ÏÏˆÓ ıÂÚ·¢ÙÈÎÒÓ ‰˘Ó·ÙÔًوÓ, ÙÔ ÎÏ›ÛÈÌÔ ÙÔ˘
‰È·ÛÙ‹Ì·ÙÔ˜ Ù˘ ÂÍ·ÁˆÁ‹˜ Ì ˘ÔηٿÛÙ·ÛË ÙÔ˘ ¿Óˆ
ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· ·fi ÙÔÓ Ï¿ÁÈÔ Â›Ó·È ÌÈ· χÛË Ô˘
Û˘Ó‹ıˆ˜ ÈηÓÔÔÈ› ÙÔ˘˜ ·ÛıÂÓ›˜. ™ÙÔ ·ÚfiÓ ¿ÚıÚÔ
·Ó·‰ÂÈÎÓ‡ÔÓÙ·È ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‚¤ÏÙÈÛÙË ·ÈÛıËÙÈ΋, ÛÙ·ÙÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË,
ÙËÓ ·ÔηٿÛÙ·ÛË Î·È ÙËÓ ÂÍ·ÙƠ̂΢ÛË ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘Û΢ÒÓ Û ٤ÙÔÈ· ÂÚÈÛÙ·ÙÈο. ∂ÈϤÔÓ
ÂÚÈÁÚ¿ÊÔÓÙ·È Î·È Û˘˙ËÙÔ‡ÓÙ·È ÔÈ ÎÏÈÓÈÎÔ› ¯ÂÈÚÈÛÌÔ›
ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÂÓfi˜ ÂÚÈÛÙ·ÙÈÎÔ‡ Ì ÂÍ·ÁˆÁ‹ ÙˆÓ
‰‡Ô ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ.
ABSTRACT
Management of cases with extraction of single or
both maxillary central incisors are very occasional in
orthodontics. Among various treatment modalities,
closure of the extraction space by substitution of
ipsilateral lateral incisor for the central incisor is
usually patient satisfactory. Various issues related to
optimum esthetics, static and functional occlusion,
restoration and individualization of orthodontic
appliances in the management of such cases are
highlighted. The clinical management of a case with
extraction of both maxillary central incisors is discussed.
§¤ÍÂȘ ÎÏÂȉȿ: √ÚıÔ‰ÔÓÙÈ΋, ˘ÔηٿÛÙ·ÛË, ¿Óˆ
ÎÂÓÙÚÈÎÔ› ÙÔÌ›˜, ¿Óˆ Ï¿ÁÈÔÈ ÙÔÌ›˜
∂ÏÏ √ÚıÔ‰ ∂Èı 2010;13:9-23.
¶·ÚÂÏ‹ÊıË: 22.07.2009 – ŒÁÈÓ ‰ÂÎÙ‹: 08.01.2010
Key words: Orthodontic replacement, maxillary central incisors, maxillary lateral incisors
Hell Orthod Rev 2010;13:9-23.
Received: 22.07.2009 – Accepted: 08.01.2010
EI™A°ø°H
INTRODUCTION
∏ ÂÍ·ÁˆÁ‹ ‹ Ë ¤ÏÏÂÈ„Ë ÂÓfi˜ ‹ ‰‡Ô ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ
Â›Ó·È ÂÚÈÛÙ·Ûȷ΋ ÛÙËÓ ÔÚıÔ‰ÔÓÙÈ΋ ÎÏÈÓÈ΋ Ú¿ÍË.
øÛÙfiÛÔ fiÙ·Ó Ù· ‰fiÓÙÈ· ·˘Ù¿ Â›Ó·È ‰˘ÛÏ·ÛÙÈο,
Extraction or missing of single or both maxillary central
incisors are occasional in orthodontics. However, when
these are malformed, grossly displaced, dilacerated,
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
9
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
ÛËÌ·ÓÙÈο ¤ÎÙÔ·, ÁˆÓÈÒ‰Ë, ¤¯Ô˘Ó ˘ÔÛÙ› οٷÁÌ·
ÏfiÁˆ ÙÚ·˘Ì·ÙÈÛÌÔ‡ ‹ ÂÌϤÎÔÓÙ·È Ì ÙÔÈ΋ ·ıÔÏÔÁ›·,
Â›Ó·È Èı·Ófi Ë ÂÍ·ÁˆÁ‹ ÙÔ˘˜ Ó· ·ÔÙÂÏ› ıÂÚ·›·
ÂÎÏÔÁ‹˜ (Gazit Î·È Lieberman, 1991; Hellekant Î·È Û˘Ó.,
2001). ∂ÈϤÔÓ, Ô ÔÚıÔ‰ÔÓÙÈÎfi˜ ÌÔÚ› Ó· ¤ÚıÂÈ
·ÓÙÈ̤وÔ˜ Ì ÂÚÈÛÙ·ÙÈο ÙÚ·˘Ì·ÙÈ΋˜ ÂÎÁfiÌʈÛ˘ ‹
Û˘ÁÁÂÓÔ‡˜ ¤ÏÏÂȄ˘ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· (Trope, 2002).
√È ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ Û ·ÛıÂÓ›˜ Ì ÂÏÏ›ÔÓÙ· ‹
ÂÍ·¯ı¤ÓÙ· ÎÂÓÙÚÈÎfi ÙÔ̤· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙË ‰È·Ù‹ÚËÛË
ÙÔ˘ ¯ÒÚÔ˘ Î·È ÙËÓ ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË Ì Á¤Ê˘Ú·
‹ ÂÌʇÙÂ˘Ì· ÌÂÙ¿ ÙËÓ ÂÓËÏÈΛˆÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ (Kokich
Î·È Û˘Ó., 1984), ÙË Û‡ÁÎÏÂÈÛË ÙÔ˘ ‰È·ÛÙ‹Ì·ÙÔ˜ Ù˘
ÂÍ·ÁˆÁ‹˜ Ì ˘ÔηٿÛÙ·ÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ ·fi ÙÔÓ
Ï¿ÁÈÔ ÙÔ̤· (Kokich Î·È Û˘Ó., 1984; Kramer Î·È Û˘Ó.,
2002) Î·È ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔÁÔÌÊ›Ô˘ (Slagsvold ηÈ
Bjercke, 1978; Czochrowska Î·È Û˘Ó., 2002; Kokich ηÈ
Crabill, 2006). √È ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙËÓ
ÂÈÏÔÁ‹ Ù˘ ÂÓ‰ÂÈÎÓ˘fiÌÂÓ˘ ıÂÚ·›·˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó
ÙÔÓ ·ÚÈıÌfi ÙˆÓ ÂÏÏÂÈfiÓÙˆÓ ‰ÔÓÙÈÒÓ, ÙȘ ˘¿Ú¯Ô˘Û˜
Û˘ÁÎÏÂÈÛȷΤ˜ Û˘Óı‹Î˜, ÙËÓ ËÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜, ÙÔ˘˜
‰È·ı¤ÛÈÌÔ˘˜ ¯ÒÚÔ˘˜, ÙÔ ÚÔÊ›Ï ÙˆÓ Ì·Ïı·ÎÒÓ ÈÛÙÒÓ ÙÔ˘
ÚÔÛÒÔ˘ ÎÏ. (Kokich Î·È Crabill, 2006). øÛÙfiÛÔ, Ë
ÚÔ˜ Ù· ÂÁÁ‡˜ ÌÂٷΛÓËÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤· ÒÛÙ ӷ
˘ÔηٷÛÙ‹ÛÂÈ ÙÔÓ ÂÏÏ›ÔÓÙ· ÎÂÓÙÚÈÎfi ÙÔ̤· ‰Â›¯ÓÂÈ Ó·
Â›Ó·È Ë Î·Ï‡ÙÂÚË ıÂÚ·¢ÙÈ΋ ÂÈÏÔÁ‹ Î·È Û ÁÂÓÈΤ˜
ÁÚ·Ì̤˜ ÂΛÓË Ô˘ ÈηÓÔÔÈ› ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜
·ÛıÂÓ›˜ (Czochrowska Î·È Û˘Ó., 2003).
√ Ù‡Ô˜ Ù˘ Û˘ÁÎÏÂÈÛȷ΋˜ ·ÓˆÌ·Ï›·˜, Ë Û˘Ó·ÚÌÔÁ‹ ÙˆÓ
Ê˘Ì¿ÙˆÓ ÙˆÓ ‰ÔÓÙÈÒÓ, ÔÈ Û˘Óı‹Î˜ ·fi ¿Ô„Ë
‰È·ı¤ÛÈÌˆÓ ¯ÒÚˆÓ .¯. Û˘ÓˆÛÙÈÛÌfi˜ ‹ ‰È·ÛÙ‹Ì·Ù·
ÌÂٷ͇ ÙˆÓ ‰ÔÓÙÈÒÓ, Ë ÂÁÁ‡˜- ¿ˆ ‰È¿ÛÙ·ÛË ÙÔ˘ Ï·Á›Ô˘
ÙÔ̤· Î·È ÙÔ Ì‹ÎÔ˜ Ù˘ Ú›˙·˜ ÙÔ˘, Ë ÌÔÚÊÔÏÔÁ›· Î·È ÙÔ
ÂÚ›ÁÚ·ÌÌ· Ù˘ ̇Ï˘ ÙÔ˘ ΢Ófi‰ÔÓÙ· Â›Ó·È Ù¤ÛÛÂÚȘ
·Ú¿ÁÔÓÙ˜ Ô˘ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÛÂ
ÂÚÈÙÒÛÂȘ Ô˘ ÚfiÎÂÈÙ·È Ô Ï¿ÁÈÔ˜ ÙÔ̤·˜ Ó·
˘ÔηٷÛÙ‹ÛÂÈ ÙÔÓ ÎÂÓÙÚÈÎfi (Tuverson, 1970). √È
ÂÚÈÙÒÛÂȘ ∆¿Í˘ π Ì ÚÔ‚Ï‹Ì·Ù· ¯ÒÚÔ˘ Î·È ∆¿Í˘ ππ
ÂӉ›ÎÓ˘ÓÙ·È ÁÈ· ÔÚıÔ‰ÔÓÙÈ΋ Û‡ÁÎÏÂÈÛË ÙÔ˘ ¯ÒÚÔ˘
(Kokich Î·È Crabill, 2006). ∞Ó Î·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›·
˘¿Ú¯Ô˘Ó Ï›Á˜ ·Ó·ÊÔÚ¤˜ Û¯ÂÙÈο Ì ÙȘ ıÂÚ·¢ÙÈΤ˜
ÂÈÏÔÁ¤˜ Û ·ÛıÂÓ›˜ Ì ÂÏÏ›ÔÓÙ˜ ‹ ÂÍ·¯ı¤ÓÙ˜ ¿Óˆ
ÎÂÓÙÚÈÎÔ‡˜ ÙÔÌ›˜, (Asher Î·È Lewis, 1986; Lin, 1999;
Kokich Î·È Crabill, 2006), η̛· ·fi ÙȘ ˘¿Ú¯Ô˘Û˜
ÌÂϤÙ˜ ‰ÂÓ ·Ó·Ê¤ÚÂÈ Ô‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙȘ ·ÈÛıËÙÈΤ˜,
Û˘ÁÎÏÂÈÛȷΤ˜ Î·È ÏÂÈÙÔ˘ÚÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜ Û ·ÛıÂÓ›˜
fiÔ˘ Ô ¿Óˆ ÎÂÓÙÚÈÎfi˜ ÙÔ̤·˜ ˘Ôηı›ÛÙ·Ù·È ·fi ÙÔÓ ¿Óˆ
Ï¿ÁÈÔ ÙÔ̤· .
∆Ô ·ÚfiÓ ¿ÚıÚÔ ·Ó·‰ÂÈÎÓ‡ÂÈ Ù· ‰È¿ÊÔÚ· ˙ËÙ‹Ì·Ù· Ô˘
10
HELLENIC ORTHODONTIC REVIEW
fractured due to trauma or associated with local pathology, extraction may become the treatment of choice
(Gazit and Lieberman, 1991; Hellekant et al., 2001). Also
sometimes orthodontist can encounter patients having
traumatically avulsed and congenitally missing maxillary central incisor (Trope, 2002).
Treatment options for patients with missing or extracted maxillary central incisor includes maintenance of
extraction space and to place a bridge or implant during
adulthood (Kokich et al., 1984), closure of extraction
space by substituting lateral incisor for central incisor
(Kokich et al., 1984; Kramer et al., 2002) and premolar
transplantation (Slagsvold and Bjercke, 1978;
Czochrowska et al., 2002; Kokich and Crabill, 2006). The
choice of appropriate treatment depends on factors like
number of missing tooth, existing occlusion, age of the
patient, space conditions, soft tissue profile of the face
etc. (Kokich and Crabill, 2006) However, replacing the
central incisor with mesial movement of the lateral
incisor seems to be the best treatment option and generally patient satisfactory (Czochrowska et al., 2003).
The type of malocclusion and cuspal interdigitation,
space condition i.e. crowding or spacing, width of lateral incisor and length of its root, and shape and contour
of canine crown are the four factors need to be considered in cases where the maxillary lateral incisor is to be
substituted for central incisor (Tuverson, 1970). Class-I
space deficiency and Class-II cases are good for orthodontic space closure (Kokich and Crabill, 2006). Few
studies are available in the literature mentioning the
treatment options for patients with missing or extracted maxillary central incisors (Asher and Lewis, 1986; Lin,
1999; Kokich and Crabill, 2006), however none of the
studies have mentioned the esthetic, occlusal and functional guidelines for patients in whom maxillary central
incisor is replaced with lateral incisor.
This article highlights the various issues to be considered
in cases in which maxillary central incisors are to be
orthodontically replaced with lateral incisors.
ISSUES TO BE CONSIDERED
Issues related to optimum esthetics
Mesiodistal position of the lateral incisor (the so-called
central incisor): The difference in width and length,
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë Û ÂÚÈÙÒÛÂȘ Ô˘
ÂÈϤÁÂÙ·È Ë ÔÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ
ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ ·fi ÙÔ˘˜ Ï·Á›Ô˘˜.
∑∏∆∏ª∞∆∞ ¶√À ¶ƒ∂¶∂π ¡∞ §∞ªµ∞¡√¡∆∞π À¶√æ∏
∑ËÙ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ‚¤ÏÙÈÛÙË ·ÈÛıËÙÈ΋
∂ÁÁ‡˜-¿ˆ ı¤ÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤· (ÙÔ˘ ·ÔηÏÔ‡ÌÂÓÔ˘
ÎÂÓÙÚÈÎÔ‡): ∏ ‰È·ÊÔÚ¿ ÛÙÔ Ï¿ÙÔ˜ Î·È ÙÔ Ì‹ÎÔ˜ ÌÂٷ͇
ÎÂÓÙÚÈÎÔ‡ Î·È Ï·Á›Ô˘ ÙÔ̤· ··ÈÙ› ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘
Ï·Á›Ô˘ ÙÔ̤· Ô˘ ÚfiÎÂÈÙ·È Ó· ˘ÔηٷÛÙ‹ÛÂÈ ÙÔÓ
ÎÂÓÙÚÈÎfi Û ηٿÏÏËÏË ı¤ÛË (Kokich Î·È Crabill, 2006).
∂Âȉ‹ ÙÔ ÚÔÊ›Ï ·Ó¿‰˘Û˘ ÙÔ˘ ¿Óˆ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤·
Â›Ó·È Û ÁÂÓÈΤ˜ ÁÚ·Ì̤˜ Â›Â‰Ô ÛÙËÓ ÂÁÁ‡˜ ÂÈÊ¿ÓÂÈ·, Ô
Ï¿ÁÈÔ˜ ÙÔ̤·˜ Ú¤ÂÈ Ó· ÌÂÙ·ÎÈÓËı› ÎÔÓÙ¿ ÛÙË Ì¤ÛË
ÁÚ·ÌÌ‹ ¤ÙÛÈ ÒÛÙÂ Ë ¿ˆ ÂÈÊ¿ÓÂÈ· Ù˘ Ù¯ÓËÙ‹˜ ̇Ï˘ Ó·
ÌÔÚ› Ó· ηٷÛ΢·Ûı› ¢ڇÙÂÚË ·fi ÙËÓ ÂÁÁ‡˜ fiÌÔÚË
ÁÈ· ·ÈÛıËÙÈÎÔ‡˜ ÏfiÁÔ˘˜ (Zachrisson, 1978; Kokich ηÈ
Crabill, 2006). ∏ ÌÂÙ·ÙÚÔ‹ Â›Ó·È Â˘ÎÔÏfiÙÂÚË fiÙ·Ó Ë
Ê˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤· ›ӷÈ
¢ÓÔ˚΋ (Kokich Î·È Crabill, 2006).
∞fiÎÏÈÛË ÙÔ˘ Ï¿ÁÈÔ˘ ÙÔ̤·: ™Â ÂÚÈÙÒÛÂȘ
ÂÙÂÚfiÏ¢Ú˘ ¤ÏÏÂȄ˘ ÂÓfi˜ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤·, ›ӷÈ
ÛÎfiÈÌÔ Ó· ‰È·ÙËÚÂ›Ù·È ÌÂٷ͇ ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤· Î·È ÙÔ˘
fiÌÔÚÔ˘ ÎÂÓÙÚÈÎÔ‡ ·Ú·ÏÏËÏfiÙËÙ· ÌÂÁ·Ï‡ÙÂÚË ÙÔ˘
Ê˘ÛÈÔÏÔÁÈÎÔ‡ (Schwaninger Î·È Shaye, 1977). ™Â
·ÌÊ›Ï¢ڷ ÂÚÈÛÙ·ÙÈο Ú¤ÂÈ Ó· ‰È·ÙËÚÂ›Ù·È Ë
·Ú·ÏÏËÏfiÙËÙ· ÌÂٷ͇ ÙˆÓ Ï·Á›ˆÓ ÙÔ̤ˆÓ. ∏
ÙÔÔı¤ÙËÛË ÙˆÓ Ï·Á›ˆÓ ÙÔ̤ˆÓ Û ı¤ÛÂȘ Ù¯ÓˤÓÙˆ˜
ÛËÌ·ÓÙÈο ‰È·ÊÔÚÂÙÈΤ˜ ·fi ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ‰ÂÓ Ô‰ËÁ›
Û ÈηÓÔÔÈËÙÈÎfi ıÂÚ·¢ÙÈÎfi ·ÔÙ¤ÏÂÛÌ· (Schwaninger
Î·È Shaye, 1977; Edwards, 1977).
∞fi‰ÔÛË Û˘ÌÌÂÙÚ›·˜ ÛÙÔ fiÚÈÔ ÙˆÓ Ô‡ÏˆÓ ÙˆÓ ¿Óˆ
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ: √ Ï¿ÁÈÔ˜ ÙÔ̤·˜ Ú¤ÂÈ Ó·
ÂÌ‚˘ıÈÛÙ› ÙfiÛÔ ÒÛÙÂ Ë ·Ú˘Ê‹ ÙˆÓ Ô‡ÏˆÓ Ó· ‚Ú›ÛÎÂÙ·È
ÛÙÔ ›‰ÈÔ Â›Â‰Ô Ì ÙÔ ÂÚ›ÁÚ·ÌÌ· ÙˆÓ Ô‡ÏˆÓ ÙÔ˘
ÁÂÈÙÔÓÈÎÔ‡ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· (Kokich Î·È Û˘Ó., 1984;
Kokich, 1993; Kokich Î·È Spear, 1997; Kokich, 1997). ∏
ÂÈϤÔÓ ÂÌ‚‡ıÈÛË ÂÈÙÚ¤ÂÈ ÙËÓ ·ÔηٿÛÙ·ÛË ÙÔ˘
‰ÔÓÙÈÔ‡ Ì ·fi‰ÔÛË ÌÔÚÊÔÏÔÁ›·˜ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤·
(Kokich Î·È Crabill, 2006). ∏ Ô˘ÏÂÎÙÔÌ‹ ÛÙÔÓ Ï¿ÁÈÔ
ÙÔ̤· (ÙÔÓ Ó¤Ô- ·ÔηÏÔ‡ÌÂÓÔ ÎÂÓÙÚÈÎfi) ÌÔÚ› Ó·
‚ÔËı‹ÛÂÈ ÛÙËÓ ·‡ÍËÛË ÙÔ˘ ‡„Ô˘˜ Ù˘ ÎÏÈÓÈ΋˜ ̇Ï˘
(Monefeldt Î·È Zachrisson, 1977). √ ¿Óˆ ΢Ófi‰ÔÓÙ·˜
(Ô˘ ı· ¿ÚÂÈ ÙË ı¤ÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤·) Ú¤ÂÈ Ó·
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
when creating a central incisor from a lateral incisor
requires correct positioning of the laterals (Kokich and
Crabill, 2006). As the emergence profile of maxillary
central incisors are generally flat on the mesial surface,
the lateral incisor should be moved close to the midline
so that an artificial crown can be made wider on the distal than on the mesial aspect for optimal esthetics
(Zachrisson, 1978; Kokich and Crabill, 2006). The transformation is also easier if the lateral incisor has a suitable natural form (Kokich and Crabill, 2006).
Angulation of the lateral incisor: When unilateral central incisor is missing, it is helpful if the lateral incisor
and adjacent central incisors are left more parallel than
normal (Schwaninger and Shaye, 1977). In bilateral
cases, both the lateral incisors should be kept parallel to
each other. Too much artistic positioning of the lateral
incisors results unsatisfactory treatment (Schwaninger
and Shaye, 1977; Edwards, 1977).
Matching the gingival margin of the maxillary anterior
teeth: The lateral incisor must be intruded so that its
gingival margin matches the adjacent central incisor
(Kokich et al., 1984; Kokich, 1993; Kokich and Spear,
1997; Kokich, 1997). Additional intrusion also allows
restoration of this tooth into shape of a central incisor
(Kokich and Crabill, 2006). Gingivectomy of the lateral
incisor (the so-called central incisor) can also increase
the clinical crown height (Monefeldt and Zachrisson,
1977). The maxillary canine (so-called lateral incisor)
must be extruded to move its gingival margin incisally
to resemble the usual gingival margin position of the socalled lateral incisors (Kokich and Crabill, 2006). Gingivoplasty and intrusion of the first premolar (the socalled canine) may also be required to match its gingival
margin.
Reshaping of the canine: Recontouring and reshaping of
the canine should be considered to give proper shape
and size of a lateral incisor. The tip of the canine should
be flat, the disto-incisal line angle should be rounded
and there should be proper mesio-distal reduction
(Tuverson, 1970). The canine eminence on the labial surface should be reduced to make it flat (Tuverson, 1970).
The lingual contour should be reduced to enhance adequate overbite and overjet and to eliminate premature
11
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
˘ÂÚÂÎÊ˘ı› ÒÛÙÂ Ë ·Ú˘Ê‹ ÙˆÓ Ô‡ÏˆÓ Ó· ÌÂÙ·ÙÔÈÛı›
ÂÚÈÛÛfiÙÂÚÔ ÎÔÙÈο ÁÈ· Ó· ÚÔÛÔÌÔÈ¿˙ÂÈ ÛÙË
Ê˘ÛÈÔÏÔÁÈ΋ ÌÔÚÊÔÏÔÁ›· ÙˆÓ Ô‡ÏˆÓ ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤·
(Kokich Î·È Crabill, 2006). ∂›Ó·È Â›Û˘ Èı·Ófi Ó·
¯ÚÂÈ·Ûı› Ô˘ÏÔÏ·ÛÙÈ΋ Î·È ÂÌ‚‡ıÈÛË ÙÔ˘ ÚÒÙÔ˘
ÚÔÁÔÌÊ›Ô˘ (Ô ÔÔ›Ô˜ ı· ¿ÚÂÈ ÙË ı¤ÛË ÙÔ˘ ΢Ófi‰ÔÓÙ·).
∆ÚÔÔÔ›ËÛË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘ ΢Ófi‰ÔÓÙ·: °È· Ó·
·Ô‰Ôı› Ë Î·Ù¿ÏÏËÏË ÌÔÚÊÔÏÔÁ›· ÛÙÔÓ Î˘Ófi‰ÔÓÙ· Ô˘
ı· ¿ÚÂÈ ÙË ı¤ÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤· ··ÈÙ›ٷÈ
ÙÚÔÔÔ›ËÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ Î·È Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘
‰ÔÓÙÈÔ‡. ∆Ô ÎÔÙÈÎfi ¿ÎÚÔ ÙÔ˘ ΢Ófi‰ÔÓÙ· Ú¤ÂÈ Ó·
ÂÈ‰ˆı› Î·È ÂÈϤÔÓ Ú¤ÂÈ Ó· ·Ô‰Ôı›
ηÌ˘ÏfiÙËÙ· ÛÙËÓ ¿ˆ ÎÔÙÈ΋ ÁˆÓ›· Î·È Ó· ÌÂȈı› Ë
ÂÁÁ‡˜ ÎÔÙÈ΋ ÁˆÓ›· (Tuverson, 1970). ™ÙË ¯ÂÈÏÈ΋ ÏÂ˘Ú¿
¯ÚÂÈ¿˙ÂÙ·È Ó· ÂÈ‰ˆı› ÙÔ Î˘ÓÔ‰ÔÓÙÈÎfi ¤·ÚÌ· (Tuverson, 1970). ∞Ó¿ÏÔÁÔ˜ ÂÎÙÚÔ¯ÈÛÌfi˜ ··ÈÙÂ›Ù·È Î·È ÛÙËÓ
˘ÂÚÒÈ· ÂÈÊ¿ÓÂÈ· ÙÔ˘ ΢Ófi‰ÔÓÙ· ÒÛÙ ӷ
·ÔηٷÛÙ·ı› ÈηÓÔÔÈËÙÈ΋ ηٷÎfiÚ˘ÊË ÂÈÎ¿Ï˘„Ë Î·È
ÔÚÈ˙fiÓÙÈ· ÚfiÙ·ÍË Î·È Ó· ÂÚÈÔÚÈÛıÔ‡Ó ÔÈ ÚfiˆÚ˜
Â·Ê¤˜ Ì ÙÔÓ Î¿Ùˆ Ï¿ÁÈÔ ÙÔ̤· (Tuverson, 1970). √
ÂÎÙÚÔ¯ÈÛÌfi˜ Ù˘ ˘ÂÚÒÈ·˜ ÂÈÊ¿ÓÂÈ·˜ Â›Ó·È ··Ú·›ÙËÙÔ˜
Î·È ÁÈ· ÙËÓ ·Ó·Î·Ù·ÓÔÌ‹ Î·È ·Ó·‰È¢ı¤ÙËÛË ÙˆÓ ÚÔ˜ Ù·
ÂÁÁ‡˜ ‰˘Ó¿ÌˆÓ, ȉȷ›ÙÂÚ· fiÙ·Ó Ë ÂÚÈÔ‰ÔÓÙÈ΋
ηٿÛÙ·ÛË ÙˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Â›Ó·È ‚‚·ÚË̤ÓË.
∆ÚÔÔÔ›ËÛË Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘ ÚÒÙÔ˘ ÚÔÁÔÌÊ›Ô˘:
°È· ÙÔ Î·Ï‡ÙÂÚÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Â›Ó·È Èı·Ófi Ó·
¯ÚÂÈ·Ûı› ·Ó·Û‡ÛÙ·ÛË ÙÔ˘ ·ÚÂÈ·ÎÔ‡ ʇ̷ÙÔ˜ ÙÔ˘
ÚÒÙÔ˘ ÚÔÁÔÌÊ›Ô˘ (Ngan Î·È Û˘Ó., 2004).
Ãڈ̷ÙÈ΋ ·fi‰ÔÛË: π‰È·›ÙÂÚË Ì¤ÚÈÌÓ· ¯ÚÂÈ¿˙ÂÙ·È ÒÛÙÂ
Ó· ˘¿ÚÍÂÈ Ù·‡ÙÈÛË ÙÔ˘ ¯ÚÒÌ·ÙÔ˜ ÌÂٷ͇ ÙˆÓ ‰ÔÓÙÈÒÓ
Ô˘ ı· ˘ÔηٷÛÙ‹ÛÔ˘Ó ÙÔÓ ÎÂÓÙÚÈÎfi Î·È Ï¿ÁÈÔ ÙÔ̤·
(Asher Î·È Lewis, 1986).
∑ËÙ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‚¤ÏÙÈÛÙË ÛÙ·ÙÈ΋
Î·È ÏÂÈÙÔ˘ÚÁÈ΋ Û‡ÁÎÏÂÈÛË
ÛÏÂÔ-˘ÂÚÒÈ· ı¤ÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤·: √ Ï¿ÁÈÔ˜
ÙÔ̤·˜ Ú¤ÂÈ Ó· ÙÔÔıÂÙËı› ÂÚÈÛÛfiÙÂÚÔ ¯ÂÈÏÈο ÒÛÙÂ
Ó· ÌÂȈı› Ë ÏÂÈÙÔ˘ÚÁÈ΋ ÊfiÚÙÈÛË Î·È Ó· ·ÔÊ¢¯ı› Ë
ÎÈÓËÙÈÎfiÙËÙ· (Schwaninger Î·È Shaye, 1977).
∫·Ù·ÎfiÚ˘ÊÔ ‡„Ô˜ Ù˘ ̇Ï˘ ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤·: ∏
Ù¯ÓËÙ‹ ̇ÏË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤· Ú¤ÂÈ Ó· Â›Ó·È 0,5 ¯ÈÏ
ÎÔÓÙ‡ÙÂÚË ·fi ÙÔ˘ fiÌÔÚÔ˘ ÎÂÓÙÚÈÎÔ‡ (Schwaninger ηÈ
Shaye, 1977). √ ΢Ófi‰ÔÓÙ·˜ ÌÂÙ¿ ÙÔÓ ÂÎÙÚÔ¯ÈÛÌfi ÌÔÚ›
12
HELLENIC ORTHODONTIC REVIEW
contact with the mandibular lateral incisor (Tuverson,
1970). Also proper lingual contouring is essential for
redistribution and redirection of the protrusive force,
particularly when anterior teeth are periodontally compromised.
Reshaping of the first premolar: The composite build-up
of the buccal cusp of the first premolar may be required
to provide optimum esthetics (Ngan et al., 2004).
Shade matching: Care should be taken for optimum
colour matching between the so-called central and lateral incisor (Asher and Lewis, 1986).
Issues related to optimum static and functional
occlusion
Labio-palatal position of the lateral incisor: The lateral
incisor should be placed somewhat labially to reduce
the functional load and to avoid jiggling (Schwaninger
and Shaye, 1977).
Vertical height of the lateral incisor crown: The artificial
crown on the lateral incisor should 0.5mm shorter than
the adjacent central incisor (Schwaninger and Shaye,
1977). The ground canine can be slightly longer than the
central incisor (formerly lateral incisor), so that they will
take the major load during mandibular excursions (Schwaninger and Shaye, 1977). When both central incisors
are replaced with lateral incisors, the crown on the lateral incisors and the ground canines should be equal
(Schwaninger and Shaye, 1977).
Inclination of the canine: There should be palatal root
torque in the canine (the so-called lateral incisor).
Posterior occlusion: There is a definite impact on interdigitation and thus on functional occlusion. However, it
is possible to establish an acceptable functional relationship even in absence of normal canine position i.e.
with group function or modified group function on the
working side of the arch (Tuverson, 1970).
Reshaping of the first premolar: It has been found that
palatal cusp of the first premolar (so-called canine) does
not interfere with the normal canine protected occlu-
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
Ó· ·Ú·Ì›ÓÂÈ ÂÏ·ÊÚÒ˜ Ì·ÎÚ‡ÙÂÚÔ˜ ·fi ÙÔÓ ÎÂÓÙÚÈÎfi
ÙÔ̤· (Ô˘ ‹Ù·Ó ÚÈÓ Ï¿ÁÈÔ˜ ÙÔ̤·˜), ÒÛÙ ӷ ·Ó·Ï¿‚ÂÈ
ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ Ù˘ ÊfiÚÙÈÛ˘ ηٿ ÙȘ ÎÈÓ‹ÛÂȘ Ù˘
οو ÁÓ¿ıÔ˘ (Schwaninger Î·È Shaye, 1977). ™ÙȘ
ÂÚÈÙÒÛÂȘ Ô˘ Î·È ÔÈ ‰‡Ô ÎÂÓÙÚÈÎÔ› ÙÔÌ›˜
˘Ôηı›ÛÙ·ÓÙ·È ·fi ÙÔ˘˜ Ï·Á›Ô˘˜ ÙÔÌ›˜, ÔÈ Ì‡Ï˜ ÙˆÓ
Ï·Á›ˆÓ ÙÔ̤ˆÓ Î·È ÙˆÓ ÂÎÙÚÔ¯ÈÛÌ¤ÓˆÓ Î˘ÓÔ‰fiÓÙˆÓ
‰È·ÌÔÚÊÒÓÔÓÙ·È ÈÛÔ¸„›˜ (Schwaninger Î·È Shaye,
1977).
∞fiÎÏÈÛË ÙÔ˘ ΢Ófi‰ÔÓÙ·: ™ÙÔÓ Î˘Ófi‰ÔÓÙ· (Ô ÔÔ›Ô˜
˘ÔηıÈÛÙ¿ ÙÔÓ Ï¿ÁÈÔ ÙÔ̤·) Ú¤ÂÈ Ó· ·Ô‰Ôı›
˘ÂÚÒÈ· ·fiÎÏÈÛË Ú›˙·˜
√›ÛıÈ· Û‡ÁÎÏÂÈÛË: ™ÙȘ ÂÚÈÙÒÛÂȘ ·˘Ù¤˜ ÂËÚ¿˙ÂÙ·È
ÛËÌ·ÓÙÈο Ë Û˘Ó·ÚÌÔÁ‹ ÙˆÓ Ê˘Ì¿ÙˆÓ ÙˆÓ ‰ÔÓÙÈÒÓ Î·È
ηٿ Û˘Ó¤ÂÈ· Ë ÏÂÈÙÔ˘ÚÁ›·. øÛÙfiÛÔ, Â›Ó·È ‰˘Ó·Ùfi Ó·
ÂÈÙ¢¯ı› ÌÈ· ÈηÓÔÔÈËÙÈ΋ ÏÂÈÙÔ˘ÚÁÈ΋ Û¯¤ÛË ·ÎfiÌ·
Î·È ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›· ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ ÛÙË
Ê˘ÛÈÔÏÔÁÈ΋ ÙÔ˘˜ ı¤ÛË, .¯. Û‡ÁÎÏÂÈÛË ÔÌ·‰È΋˜
ÚÔÛÙ·Û›·˜ ‹ ÙÚÔÔÔÈË̤Ó˘ ÔÌ·‰È΋˜ ÚÔÛÙ·Û›·˜ ÛÙËÓ
ÂÚÁ·˙fiÌÂÓË ÏÂ˘Ú¿ (Tuverson, 1970).
∞ÏÏ·Á‹ Ù˘ ÌÔÚÊÔÏÔÁ›·˜ ÙÔ˘ ÚÒÙÔ˘ ÚÔÁfiÌÊÈÔ˘: Œ¯ÂÈ
‚ÚÂı› fiÙÈ ÙÔ ˘ÂÚÒÈÔ Ê‡Ì· ÙÔ˘ ÚÒÙÔ˘ ÚÔÁfiÌÊÈÔ˘
(Ô˘ ·›ÚÓÂÈ ÙË ı¤ÛË ÙÔ˘ ΢Ófi‰ÔÓÙ·) ‰ÂÓ ·ÚÂÌ‚¿ÏÏÂÙ·È
ÛÙË Ê˘ÛÈÔÏÔÁÈ΋ Û‡ÁÎÏÂÈÛË Î˘ÓÔ‰ÔÓÙÈ΋˜ ÚÔÛÙ·Û›·˜
(McNeill Î·È Joondeph, 1973), øÛÙfiÛÔ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ
Ó· ÂÎÙÚÔ¯ÈÛı› ÙÔ ˘ÂÚÒÈÔ Ê‡Ì· ÙÔ˘ ÚÔÁfiÌÊÈÔ˘ ÒÛÙÂ
Ó· ÌË ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·ÚÂÌ‚ÔϤ˜ ÛÙË ÌË ÂÚÁ·˙fiÌÂÓË
ÏÂ˘Ú¿ ηٿ ÙȘ Ï¿ÁȘ ÎÈÓ‹ÛÂȘ (Tuverson, 1970; Asher
Î·È Lewis, 1986). ∂ÈϤÔÓ Ë ·ÏÏ·Á‹ Ù˘ ÌÔÚÊÔÏÔÁ›·˜
··ÈÙÂ›Ù·È ÁÈ· Ó· ·ÔʇÁÔÓÙ·È ÔÈ ÚfiˆÚ˜ Â·Ê¤˜ ÌÂ
ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Û ÎÂÓÙÚÈ΋ Û‡ÁÎÏÂÈÛË (Asher ηÈ
Lewis, 1986).
∑ËÙ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË ‚¤ÏÙÈÛÙË ·ÔηٿÛÙ·ÛË
∏ÏÈΛ· ÙÔ˘ ·ÛıÂÓÔ‡˜: ™Â Ó·ÚÔ‡˜ ·ÛıÂÓ›˜ ıÂÚ·›·
ÂÎÏÔÁ‹˜ ıˆÚÂ›Ù·È Ë ·Ó·Û‡ÛÙ·ÛË ÙÔ˘ Ï·Á›Ô˘ Ô˘
˘ÔηıÈÛÙ¿ ÙÔÓ ÎÂÓÙÚÈÎfi ÙÔ̤· Ì ۇÓıÂÙË ÚËÙ›ÓË Î·ıÒ˜
ÚfiÎÂÈÙ·È ÁÈ· ·Ú¤Ì‚·ÛË ·ÓÙÈÛÙÚÂÙ‹ Î·È ÌË
ηٷÛÙÚÔÊÈ΋ (Asher Î·È Lewis, 1986). ÕÏψÛÙ ٷ
ÓÂfiÙÂÚ· Û‡ÓıÂÙ· ˘ÏÈο Â›Ó·È ‚ÂÏÙȈ̤ӷ ·fi ÏÂ˘Ú¿˜
¯ÚˆÌ·ÙÈ΋˜ ÛÙ·ıÂÚfiÙËÙ·˜ Î·È ·ÓÙÔ¯‹˜ ÛÙËÓ ·ÔÙÚÈ‚‹.
∫·Ù¿ÏÏËÏÔ˜ ¯ÚfiÓÔ˜ ÁÈ· ÙËÓ ·ÔηٿÛÙ·ÛË: ™Â ·ÛıÂÓ›˜ ÌÂ
·ÓÒÌ·ÏË ÌÔÚÊÔÏÔÁ›· Ï·Á›ˆÓ ÙÔ̤ˆÓ, Û˘¯Ó¿ ›ӷÈ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
sion (McNeill and Joondeph, 1973), but it is better to
grind the palatal cusp of first premolar which assumes
the canine position so that balancing side interference
does not occur during the lateral excursions (Tuverson,
1970; Asher and Lewis, 1986). Also recontouring is necessary to avoid premature contact with the opposing
teeth in centric occlusion (Asher and Lewis, 1986).
Issues related to optimum restoration
Age of the patient: Composite buildup of the so-called
central incisor is a reversible and non-destructive in
nature and should be considered as the treatment of
choice in young patients (Asher and Lewis, 1986). Also
the recently available composites are superior both in
their colour stability and resistance to abrasion.
Timing of the restoration: In those patients in whom the
shape of the lateral incisors is abnormal, it may be
preferable to carry out the composite restoration prior
to the beginning of orthodontic treatment. This not
only facilitates bracket positioning but also in cases in
which unilateral central incisor is to be replaced with
lateral incisor, it equalizes the width with the contralateral central incisor. However in majority of the cases, the
restorative treatment is carried out following the orthodontic treatment.
Individual crown vs. fixed crowns: As the root length of
the lateral incisor is less as compared to the central
incisor, it will not be able to tolerate the optimum protrusive force. Thus it is reasonable to include canines in
the prosthesis to distribute protrusive force over four
teeth. When it is planned for the single crown as common in the situation of unilateral missing central incisor,
the overbite in the so-called central incisor should be
kept slightly less than normal to prevent excessive lateral stress on it during the protrusive movement.
Issues related to fixed orthodontic appliance
Maxillary arch wire modification in standard edgewise
appliance
In the standard edgewise appliance, the following modifications in the arch wire are essential for optimum
esthetics and function (Tuverson, 1970):
13
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
ÚÔÙÈÌfiÙÂÚÔ Ë ·Ó·Û‡ÛÙ·ÛË Ó· ÚÔËÁÂ›Ù·È Ù˘
ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜. ªÂ ÙÔÓ ÙÚfiÔ ·˘Ùfi fi¯È ÌfiÓÔ
‰È¢ÎÔχÓÂÙ·È Ë Û˘ÁÎfiÏÏËÛË ÙÔ˘ ÔÚıÔ‰ÔÓÙÈÎÔ‡ ·ÁÎ˘Ï›Ô˘
·ÏÏ¿ ÛÙȘ ÂÙÂÚfiÏ¢Ú˜ ÂÚÈÙÒÛÂȘ, fiÔ˘ Ô Ï¿ÁÈÔ˜
ÙÔ̤·˜ ˘ÔηıÈÛÙ¿ ÙÔÓ ÎÂÓÙÚÈÎfi ÌfiÓÔ ÛÙË ÌÈ· ÏÂ˘Ú¿,
Â›Ó·È ‰˘Ó·Ù‹ Ë ÂÍÔÌÔ›ˆÛË ÙÔ˘ ‡ÚÔ˘˜ ÙÔ˘ Ì ÙÔÓ ÎÂÓÙÚÈÎfi
ÙÔ̤· Ù˘ ·ÓÙ›ıÂÙ˘ ÏÂ˘Ú¿˜. øÛÙfiÛÔ, ÛÙËÓ ÏÂÈÔÓfiÙËÙ·
ÙˆÓ ÂÚÈÙÒÛÂˆÓ Ë ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË Á›ÓÂÙ·È ÌÂÙ¿
ÙÔ ¤Ú·˜ Ù˘ ÔÚıÔ‰ÔÓÙÈ΋˜ ıÂÚ·›·˜.
ªÂÌÔӈ̤Ó˜ ‹ Û˘Ó‰Â‰Â̤Ó˜ ÛÙÂÊ¿Ó˜: ∂Âȉ‹ ÙÔ Ì‹ÎÔ˜
Ù˘ Ú›˙·˜ ÙÔ˘ Ï·Á›Ô˘ Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi ÙÔ˘ ÎÂÓÙÚÈÎÔ‡
ÙÔ̤·, ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ·Ó¯ı› ÈηÓÔÔÈËÙÈο ÙË
ÊfiÚÙÈÛË ÙˆÓ ÚÔ˜ Ù· ÂÁÁ‡˜ ‰˘Ó¿ÌˆÓ. ∫·Ù¿ Û˘Ó¤ÂÈ·,
›ӷÈ
ÚÔÙÈÌfiÙÂÚÔ
ÛÙËÓ
·ÔηٿÛÙ·ÛË
Ó·
ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈ Î˘Ófi‰ÔÓÙ˜ Î·È Ó· Á›ÓÂÙ·È
Ó·ÚıËÎÔÔ›ËÛË ÙˆÓ ÙÂÛÛ¿ÚˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ ÁÈ· ÙËÓ
ηχÙÂÚË Î·Ù·ÓÔÌ‹ ÙˆÓ ‰˘Ó¿ÌˆÓ. ™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘
ÚfiÎÂÈÙ·È Ó· ηٷÛ΢·Ûı› ÌÂÌÔӈ̤ÓË ÛÙÂÊ¿ÓË fiˆ˜
Û ÂÙÂÚfiÏ¢ÚË ¤ÏÏÂÈ„Ë ÙÔ˘ ÂÓfi˜ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤·, Ë
ηٷÎfiÚ˘ÊË ÂÈÎ¿Ï˘„Ë ÛÙÔÓ Ï¿ÁÈÔ ÙÔ̤· Ô˘
˘ÔηıÈÛÙ¿ ÙÔÓ ÎÂÓÙÚÈÎfi Ú¤ÂÈ Ó· Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi
ÙÔ Ê˘ÛÈÔÏÔÁÈÎfi ÒÛÙ ӷ ·ÔʇÁÂÙ·È Ë ˘¤ÚÌÂÙÚË
Ï¿ÁÈ· ÊfiÚÙÈÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ ηٿ ÙËÓ ÚÔÔÏ›ÛıËÛË.
∑ËÙ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙȘ ¿ÁȘ ÔÚıÔ‰ÔÓÙÈΤ˜
Û˘Û΢¤˜
∆ÚÔÔÔ›ËÛË ÙÔ˘ ÙfiÍÔ˘ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ÛÂ Û˘Û΢¤˜
standard edgewise
ŸÙ·Ó ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ë Ù¯ÓÈ΋ standard edgewise, ›ӷÈ
··Ú·›ÙËÙ˜ ÁÈ· ÙË ‚¤ÏÙÈÛÙË ·ÈÛıËÙÈ΋ Î·È ÏÂÈÙÔ˘ÚÁ›· ÔÈ
·ÎfiÏÔ˘ı˜ ÙÚÔÔÔÈ‹ÛÂȘ (Tuverson, 1970):
ñ ¶·Ú¿ÏË„Ë Ù˘ Û˘Ó‹ıÔ˘˜ ο̄˘ ÚÔ˜ Ù· ¤Íˆ (offset
bend) ÛÙË ı¤ÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤·, ηıÒ˜ Ô
΢Ófi‰ÔÓÙ·˜ Ô˘ ˘ÔηıÈÛÙ¿ ÙÒÚ· ÙÔÓ Ï¿ÁÈÔ ÙÔ̤·
Â›Ó·È Â˘Ú‡ÙÂÚÔ˜ ¯ÂÈÏÂÔ-ÁψÛÛÈο
ñ ∞fi‰ÔÛË ˘ÂÚÒÈ·˜ ·fiÎÏÈÛ˘ Ú›˙·˜ ÛÙÔÓ Î˘Ófi‰ÔÓÙ·
ñ ∞fi‰ÔÛË ‹ÈˆÓ Î¿Ì„ÂˆÓ Î˘ÓÔ‰ÔÓÙÈ΋˜ ηÌ˘ÏfiÙËÙ·˜
(canine offset bends) Î·È ·ÚÂȷ΋˜ ·fiÎÏÈÛ˘ Ú›˙·˜
ÛÙÔÓ ÚÒÙÔ ÚÔÁfiÌÊÈÔ
ñ ™Â ÂÚÈÙÒÛÂȘ Ô˘ Ë Û‡ÁÎÏÂÈÛË Î·Ù·Ï‹ÁÂÈ Û ۯ¤ÛË
ÁÔÌÊ›ˆÓ ∆¿Í˘ ππ, fiˆ˜ Û˘Ì‚·›ÓÂÈ fiÙ·Ó ‰ÂÓ Á›ÓÔÓÙ·È
ÂÍ·ÁˆÁ¤˜ ÛÙÔ Î¿Ùˆ Ô‰ÔÓÙÈÎfi ÙfiÍÔ, ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È
ο̄ÂȘ bayonet ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÁÔÌÊ›Ô˘˜ ÁÈ· ÙËÓ ¿ˆ
ÂÚÈÛÙÚÔÊ‹ ÙÔ˘˜.
14
HELLENIC ORTHODONTIC REVIEW
ñ No typical offset bend for the so-called lateral incisor,
as canine has thick labio-palatal dimension.
ñ Palatal root torque in canine.
ñ Mild canine offset bends and buccal root torque in
the first premolar.
ñ When occlusion is to be finished in Class-II molar
relation as in mandibular non-extraction cases, there
should not be any first molar bayonet bends for
molar rotation.
When canines are used as lateral incisors, there is generally a slight change in dental arch form, which is characterized by a flattening of the canine corner (Henn,
1974). However, arch form can be normally maintained
by positioning the first premolar i.e. by giving canine
eminence for first premolar (Henn, 1974). However, the
problem with this is usually gingival recession due to
vigorous tooth brushing of the first premolars placed
too far buccally (Henn, 1974). As the root length of first
premolar is small as comparison to the canine, there is
also risk of overloading on the working side in functional movements. Thus it is wise not to give excess eminence and buccal root torque for first premolar (the socalled canine) but rather to accept a slightly different
arch form than normal (Zachrisson, 1978).
Bracket individualization in the preadjusted edgewise
appliance
The central incisor brackets should be placed on the lateral incisor, specifically in cases of unilateral central
incisor missing. This is because the wide central incisor
bracket will be more efficient in maintaining the
mesiodistal angulation of the lateral incisor and will
also maintain the normal inclination as it is in the adjacent central incisor. As the canine require palatal root
torque, the mandibular premolar bracket with keeping
gingival wing occlusal or maxillary premolar bracket
with keeping gingival wings occlusal (bracket inversion
or upside down) should be placed on the canines. The
maxillary canine bracket should be placed on the first
premolar, so that there would be very minimum buccal
root torque on the first premolar.
Issues related to retention
Reopening of the space is a common problem when the
treatment is complete. Retention is extremely important
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
™ÙȘ ÂÚÈÙÒÛÂȘ Ô˘ ÔÈ Î˘Ófi‰ÔÓÙ˜ ˘ÔηıÈÛÙÔ‡Ó ÙÔ˘˜
Ï¿ÁÈÔ˘˜ ÙÔÌ›˜, ·Ú·ÙËÚÂ›Ù·È ÌÈ· ÂÏ·ÊÚ¿ ·ÏÏ·Á‹ ÛÙË
ÌÔÚÊ‹ ÙÔ˘ ÙfiÍÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÂÈ¤‰ˆÛË ÛÙȘ
ÁˆÓ›Â˜ ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ (Henn, 1974). ¶·Ú’ fiÏ· ·˘Ù¿ Ë
ÌÔÚÊ‹ ÙÔ˘ ÙfiÍÔ˘ ÌÔÚ› Ó· ‰È·ÙËÚËı› Ì ηٿÏÏËÏË
‰È¢ı¤ÙËÛË
ÙˆÓ
ÚÒÙˆÓ
ÚÔÁÔÌÊ›ˆÓ,
.¯.
‰ËÌÈÔ˘ÚÁÒÓÙ·˜ ΢ÓÔ‰ÔÓÙÈÎfi ¤·ÚÌ· Ì ÙÔÓ ÚÒÙÔ
ÚÔÁfiÌÊÈÔ (Henn, 1974). ™Â Ù¤ÙÔȘ ÂÚÈÙÒÛÂȘ ¤Ó·
Úfi‚ÏËÌ· Ô˘ ÌÔÚ› Ó· ÚÔ·„ÂÈ fiÙ·Ó ÙÔÔıÂÙËıÔ‡Ó
Ôχ ·ÚÂȷο ÔÈ ÚÒÙÔÈ ÚÔÁfiÌÊÈÔÈ Â›Ó·È Ë ˘Ê›˙ËÛË
ÙˆÓ Ô‡ÏˆÓ ·fi Â›ÌÔÓÔ ‚Ô‡ÚÙÛÈÛÌ· ÙˆÓ ‰ÔÓÙÈÒÓ (Henn,
1974). ∂ÈϤÔÓ, ÂÂȉ‹ ÙÔ Ì‹ÎÔ˜ Ù˘ Ú›˙·˜ ÙÔ˘ ÚÒÙÔ˘
ÚÔÁÔÌÊ›Ô˘ Â›Ó·È ÌÈÎÚfiÙÂÚÔ Û ۇÁÎÚÈÛË Ì ÙÔ˘
΢Ófi‰ÔÓÙ·, ˘¿Ú¯ÂÈ Î›Ó‰˘ÓÔ˜ ˘ÂÚÊfiÚÙˆÛ˘ ÛÙËÓ
ÂÚÁ·˙fiÌÂÓË ÏÂ˘Ú¿ ηٿ ÙȘ ÏÂÈÙÔ˘ÚÁÈΤ˜ ÎÈÓ‹ÛÂȘ. °È·
ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜ Â›Ó·È ÚÔÙÈÌfiÙÂÚÔ Ó· ÌËÓ
‰ËÌÈÔ˘ÚÁÂ›Ù·È ¤ÓÙÔÓË Î·Ì˘ÏfiÙËÙ· Î·È ·ÚÂȷ΋
·fiÎÏÈÛË Ú›˙·˜ ÛÙÔÓ ÚÒÙÔ ÚÔÁfiÌÊÈÔ (Ô ÔÔ›Ô˜
˘ÔηıÈÛÙ¿ ÙÔÓ Î˘Ófi‰ÔÓÙ·) Î·È Ó· ·ԉ¯fiÌ·ÛÙ ÌÈ·
ÂÏ·ÊÚÒ˜ ‰È·ÊÔÚÂÙÈ΋ ÌÔÚÊ‹ ÙfiÍÔ˘ (Zachrisson, 1978).
∂Í·ÙÔÌÈÎÂ˘Ì¤ÓË ÙÔÔı¤ÙËÛË ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ
·ÁÎ˘Ï›ˆÓ Û ÚÔ-ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Ù¯ÓÈ΋ Edgewise
™ÙÔÓ Ï¿ÁÈÔ ÙÔ̤· ı· Ú¤ÂÈ Ó· Û˘ÁÎÔÏÏËı› ·Á·ÏÈÔ
ÎÂÓÙÚÈÎÔ‡ ÙÔ̤·, ȉȷ›ÙÂÚ· Û ÂÚÈÙÒÛÂȘ ÂÙÂÚfiÏ¢Ú˘
¤ÏÏÂȄ˘ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤·. ∆Ô Â˘Ú‡ ·Á·ÏÈÔ ÙÔ˘
ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· Â›Ó·È ÈÔ ·ÔÙÂÏÂÛÌ·ÙÈÎfi ÛÙÔ Ó· ‰È·ÙËÚ›
ÙËÓ Î·Ù¿ÏÏËÏË ÂÁÁ‡˜-¿ˆ ·fiÎÏÈÛË ÙÔ˘ Ï·Á›Ô˘ ÙÔ̤·
Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÎÏ›ÛË Û ۯ¤ÛË Ì ÙÔÓ ÎÂÓÙÚÈÎfi ÙÔ̤·
Ù˘ ·ÓÙ›ıÂÙ˘ ÏÂ˘Ú¿˜. ∂Âȉ‹ ÛÙÔÓ Î˘Ófi‰ÔÓÙ· ¯ÚÂÈ¿˙ÂÙ·È
Ó· ·Ô‰Ôı› ˘ÂÚÒÈ· ·fiÎÏÈÛË Ú›˙·˜, ÚÔÙ›ÓÂÙ·È Ë
¯Ú‹ÛË ·ÁÎ˘Ï›Ô˘ οو ‹ ¿Óˆ ÚÔÁÔÌÊ›Ô˘ ÌÂ
ÚÔÛ·Ó·ÙÔÏÈÛÌfi ÙˆÓ Ô˘ÏÈÎÒÓ ÙÂÚ˘Á›ˆÓ ÚÔ˜ Ù·
ÎÔÙÈο (·ÓÙ›ÛÙÚÔÊË ÙÔÔı¤ÙËÛË ·ÁÎ˘Ï›Ô˘). ™ÙÔÓ ÚÒÙÔ
ÚÔÁfiÌÊÈÔ Ú¤ÂÈ Ó· Û˘ÁÎÔÏÏËı› ·Á·ÏÈÔ ¿Óˆ
΢Ófi‰ÔÓÙ· ÒÛÙ ӷ ·Ô‰Ôı› ÂÏ¿¯ÈÛÙË ·ÚÂȷ΋
·fiÎÏÈÛË ÛÙË Ú›˙· ÙÔ˘.
∑ËÙ‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Û˘ÁÎÚ¿ÙËÛË
ŒÓ· Û˘¯Ófi Úfi‚ÏËÌ· Ô˘ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÌÂÙ¿ ÙÔ ¤Ú·˜
Ù˘ ıÂÚ·›·˜ Â›Ó·È Ë Â·ÓÂÌÊ¿ÓÈÛË ‰È·ÛÙËÌ¿ÙˆÓ. °È· ÙÔ
ÏfiÁÔ ·˘Ùfi Â›Ó·È ÂÍ·ÈÚÂÙÈ΋˜ ÛËÌ·Û›·˜ Ë Ì·ÎÚ¿ ÂÚ›Ô‰Ô˜
Û˘ÁÎÚ¿ÙËÛ˘ (Zachrisson, 1977).
∞¡∞º√ƒ∞ ¶∂ƒπ™∆∞∆π∫√À
∞ÁfiÚÈ 16 ÂÙÒÓ ÚÔÛ‹Ïı ÁÈ· ÂͤٷÛË Ì ·ÚÈÔ Úfi‚ÏËÌ·
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
and long-term retention may require avoiding the
reopening of space (Zachrisson, 1977).
CASE REPORT
A 16-year old boy reported with chief complaint of
malaligned upper and lower front teeth. On clinical
examination, he had mesoprosopic and apparently symmetrical face, convex facial profile with protrusive lips
(Fig. 1). He had the history of trauma to the upper anterior teeth when he was 10 years of old. Both the maxillary central incisors were fractured. The maxillary left
central and lateral incisors were endodontically treated.
He had Angle’s Class-I molar relationship bilaterally
with severe crowding in the maxillary and mandibular
anterior teeth region and proclined maxillary and
mandibular incisors (Fig. 2). Radiographic examination
revealed severe root resorption in both the maxillary
central incisors (Fig. 3). Treatment objectives included
correction of the crowding, retraction of the anterior
teeth, correction of the lip protrusion and maintenance
of the Class-I molar relationship.
After realizing the all-possible treatment alternatives,
extraction of the both central incisors from the maxillary
arch and first premolars from the mandibular arch was
planned. The objective of extracting the central incisors
rather than first premolars from the maxillary arch was
that they were with poor prognosis. In the mandibular
arch, first premolars were extracted to relieve the
crowding and retraction of the anterior teeth. A diagnostic wax set-up (Kesling set-up) was constructed to
simulate the final occlusal scheme for the patient.
In the first phase of the treatment, alignment of the
teeth, position of the maxillary lateral incisors in the
place of maxillary central incisors, retraction of the anterior teeth, correction of the lip protrusion were achieved
and bilateral Class-I molar relationship was maintained
(Fig. 4 and 5). Also in the first phase of treatment, gingivectomy of the so-called central incisors was done to
improve the level of gingival margin (Fig. 6). In the second phase of the treatment, permanent restoration
involving both so-called central and lateral incisors were
placed, and palatal cusp of the so-called canines was
reduced (Fig. 7). The case was treated with preadjusted
edgewise appliance (Roth prescription, 0.022" slot) to
achieve first phase treatment objectives.
15
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
A
16
∂ÈÎ. 1. E͈ÛÙÔÌ·ÙÈΤ˜ ʈÙÔÁڷʛ˜ ÚÈÓ ÙË ıÂÚ·›· (A Î·È B)
ηٷ‰ÂÈÎÓ‡Ô˘Ó ¤Ó· ̤ÛÔ Ù‡Ô
ÚÔÛÒÔ˘, Û˘ÌÌÂÙÚÈÎfi ÌÂ
΢ÚÙfi ÚÔÊ›Ï Î·È ÚÔÙÂٷ̤ӷ
¯Â›ÏË.
Fig. 1. Pretreatment extra-oral
photographs (A and B) showing
mesoprosopic and apparently
symmetrical face, convex facial
profile with protrusive lips.
B
ÙËÓ ·ÓÒÌ·ÏË ı¤ÛË ÙˆÓ ¿Óˆ Î·È Î¿Ùˆ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ
ÙÔ˘. ™ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË Ô Ù‡Ô˜ ÙÔ˘ ÚÔÛÒÔ˘
¯·Ú·ÎÙËÚ›ÛÙËΠˆ˜ ̤ÛÔ˜, Û˘ÌÌÂÙÚÈÎfi˜ Ì ΢ÚÙfi ÚÔÊ›Ï
Î·È ÚÔÙÂٷ̤ӷ ¯Â›ÏË (∂ÈÎ. 1). √ ·ÛıÂÓ‹˜ ›¯Â ÈÛÙÔÚÈÎfi
ÙÚ·˘Ì·ÙÈÛÌÔ‡ ÙˆÓ ¿Óˆ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Û ËÏÈΛ· 10
ÂÙÒÓ. ∫·È ÔÈ ‰‡Ô ¿Óˆ ÎÂÓÙÚÈÎÔ› ÙÔÌ›˜ ›¯·Ó ˘ÔÛÙ›
οٷÁÌ·. √ ·ÚÈÛÙÂÚfi˜ ¿Óˆ ÎÂÓÙÚÈÎfi˜ ÙÔ̤·˜ Î·È ÔÈ ¿Óˆ
Ï¿ÁÈÔÈ ÙÔÌ›˜ ›¯·Ó ıÂÚ·¢ı› ÂÓ‰Ô‰ÔÓÙÈο.
¶·ÚÔ˘Û›·˙ ÌÈ· Û˘ÁÎÏÂÈÛȷ΋ ·ÓˆÌ·Ï›· ∆¿Í˘ π ηٿ
Anlge ·ÌÊ›Ï¢ڷ Ì ¤ÓÙÔÓÔ Û˘ÓˆÛÙÈÛÌfi ÙˆÓ ¿Óˆ ηÈ
οو ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Î·È ¯ÂÈÏÈ΋ ·fiÎÏÈÛË ¿Óˆ ηÈ
οو ÙÔ̤ˆÓ (∂ÈÎ. 2). ∞ÎÙÈÓÔÁÚ·ÊÈο ‰È·ÈÛÙÒıËÎÂ
ÛËÌ·ÓÙÈ΋ ·ÔÚÚfiÊËÛË Ù˘ Ú›˙·˜ Î·È ÙˆÓ ‰‡Ô ¿Óˆ
ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ (∂ÈÎ. 3). √È ÛÙfi¯ÔÈ Ù˘ ıÂÚ·›·˜
ÂÚÈÂÏ¿Ì‚·Ó·Ó ÙËÓ Â›Ï˘ÛË ÙÔ˘ Û˘ÓˆÛÙÈÛÌÔ‡, ¤ÏÍË ÙˆÓ
Ù· ¿ˆ ÙˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ, ‰ÈfiÚıˆÛË Ù˘ ÚfiÙ·Í˘
ÙˆÓ ¯ÂÈϤˆÓ Î·È ‰È·Ù‹ÚËÛË Ù˘ ∆¿Í˘ π ÛÙË Û¯¤ÛË ÙˆÓ
ÁÔÌÊ›ˆÓ.
ªÂÙ¿ ·fi ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi fiÏˆÓ ÙˆÓ Èı·ÓÒÓ
ıÂÚ·¢ÙÈÎÒÓ ÂÈÏÔÁÒÓ, ·Ú·ÁÚ·ÌÌ·Ù›ÛıËÎÂ Ë ÂÍ·ÁˆÁ‹
ÙˆÓ ‰‡Ô ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ Î·È ÙˆÓ Î¿Ùˆ ÚÒÙˆÓ
ÚÔÁÔÌÊ›ˆÓ. √ ÏfiÁÔ˜ Ô˘ ·ÔÊ·Û›ÛÙËÎÂ Ë ÂÍ·ÁˆÁ‹ ÙˆÓ
¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ Î·È fi¯È ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ
Â›Ó·È fiÙÈ Â›¯·Ó η΋ ÚfiÁÓˆÛË. ™ÙÔ Î¿Ùˆ Ô‰ÔÓÙÈÎfi ÙfiÍÔ
¤ÁÈÓ ÂÍ·ÁˆÁ‹ ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ Ì ÛÎÔfi Ó·
‰È¢ıÂÙËı› Ô Û˘ÓˆÛÙÈÛÌfi˜ Î·È Ó· Á›ÓÂÈ ¤ÏÍË ÙˆÓ
HELLENIC ORTHODONTIC REVIEW
By aligning the maxillary lateral incisors in place of central incisors and placing restoration on them with appropriate dimensions, the final result was esthetically and
functionally acceptable.
DISCUSSION
This article describes the various issues to be considered
in patients in whom missing or extracted maxillary central incisors are replaced with lateral incisors. When the
maxillary lateral incisors are substituted for the central
incisors, several important issues must be considered to
ensure a satisfactory result. The substitution of a lateral
incisor for central incisor is sometimes questioned
(Czochrowska et al., 2003). Concerns may be expressed
related to the treatment complexity, the risk of space
reopening, the increased load on the root of lateral
incisor when supporting the larger crown of central
incisor and the quality of the esthetic result. A recent
study on the outcome of orthodontic space closure with
a missing maxillary central incisor revealed that the
replacement of the central incisor by lateral incisor was
challenging and more time consuming, the restorative
reshaping of a lateral incisor to central incisor morphology was difficult and patients were more concern about
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
A
°
¢
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ ÚÔ˜ Ù· ¿ˆ. °È· ÙËÓ Úfi‚ÏÂ„Ë ÙÔ˘
ÙÂÏÈÎÔ‡ Û˘ÁÎÏÂÈÛÈ·ÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ ¤ÁÈÓ ‰È·ÁÓˆÛÙÈÎfi
Τڈ̷ (Kesling set-up).
™ÙËÓ ÚÒÙË Ê¿ÛË ıÂÚ·›·˜, Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ
¢ıÂÈ·ÛÌfi˜ ÙˆÓ ‰ÔÓÙÈÒÓ, ÌÂٷΛÓËÛË ÙˆÓ ¿Óˆ Ï·Á›ˆÓ
ÙÔ̤ˆÓ ÛÙË ı¤ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ, ¤ÏÍË ÙˆÓ
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
B
∂ÈÎ. 2. ∂Ó‰ÔÛÙÔÌ·ÙÈΤ˜ ʈÙÔÁڷʛ˜ Ô˘ ·ÂÈÎÔÓ›˙Ô˘Ó ·ÌÊÔÙÂÚfiÏ¢ÚË ∆¿ÍË π Û¯¤ÛË ÁÔÌÊ›ˆÓ, Ù· ηٿÁÌ·Ù· ÙˆÓ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ, ¤ÓÙÔÓÔ Û˘ÓˆÛÙÈÛÌfi ÙˆÓ ¿Óˆ Î·È Î¿Ùˆ ÚÔÛı›ˆÓ ÂÚÈÔ¯ÒÓ.
Fig. 2. Intra-oral photographs (A-E) showing bilateral Angle’s
Class-I molar relationship with fractured central incisors, severe
crowding in the upper and lower anterior regions.
E
space reopening (Czochrowska et al., 2003). However,
when the lateral incisors are mesialized to the place of
central incisors, a new alveolar process is established
with attached gingival and intact interdental papilla,
and is preserved during the continuous growth of the
dentofacial complex (Czochrowska et al., 2003).
17
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
∂ÈÎ. 3. OÈÛıÔÊ·ÙÓȷ΋
·ÎÙÈÓÔÁÚ·Ê›· ÚÈÓ ·fi
ÙË ıÂÚ·›·, Ô˘ ·ÂÈÎÔÓ›˙ÂÈ ÙËÓ ·ÙÂÏ‹ ‰È¿Ï·ÛË ÙˆÓ ÚÈ˙ÒÓ ÙˆÓ
ÎÂÓÙÚÈÎÒÓ
ÙÔ̤ˆÓ
ηıÒ˜ Î·È ÙÔ˘˜ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ˘˜
ÎÂÓÙÚÈÎfi Î·È Ï¿ÁÈÔ
ÙÔ̤· ¿Óˆ ·ÚÈÛÙÂÚ¿.
Fig. 3. Pretreatment
intra-oral
periapical
radiograph
showing
poorly developed roots
of central incisors and
root canal treated left
central and lateral
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ ÚÔ˜ Ù· ¿ˆ, ‰ÈfiÚıˆÛË Ù˘
ÚÔ¤ÙÂÈ·˜ ÙˆÓ ¯ÂÈÏÈÒÓ Î·È ‰È·ÙËÚ‹ıËÎÂ Ë ∆¿ÍË π ÛÙË
Û¯¤ÛË ÙˆÓ ÁÔÌÊ›ˆÓ ·ÌÊ›Ï¢ڷ (∂ÈÎ. 4 Î·È 5). ∂ÈϤÔÓ
ÛÙËÓ ÚÒÙË Ê¿ÛË Ù˘ ıÂÚ·›·˜ Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ
Ô˘ÏÂÎÙÔÌ‹ ÛÙÔ˘˜ Ï·Á›Ô˘˜ Ô˘ ˘Ôη٤ÛÙËÛ·Ó ÙÔ˘˜
ÎÂÓÙÚÈÎÔ‡˜ ÒÛÙ ӷ ‚ÂÏÙȈı› ÙÔ ÂÚ›ÁÚ·ÌÌ· ÙˆÓ Ô‡ÏˆÓ
(∂ÈÎ. 6). ™ÙË ‰Â‡ÙÂÚË Ê¿ÛË ıÂÚ·›·˜, ¤ÁÈÓ·Ó ÔÈ ÌfiÓÈ̘
ÚÔÛıÂÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÙˆÓ ‰ÔÓÙÈÒÓ Ô˘ ‹Ú·Ó ÙË
ı¤ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ Î·È Ï·Á›ˆÓ ÙÔ̤ˆÓ ηÈ
ÙÚÔ¯›ÛÙËΠÙÔ ˘ÂÚÒÈÔ Ê‡Ì· ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ
Ô˘ ˘Ôη٤ÛÙËÛ·Ó ÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ (∂ÈÎ. 7). ™ÙË
ıÂÚ·›· ¯ÚËÛÈÌÔÔÈ‹ıËΠÚÔ-ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ
Û‡ÛÙËÌ· edgewise (Roth prescription 0.022’’ slot) ÒÛÙÂ
Ó· ÂÈÙ¢¯ıÔ‡Ó ÔÈ ıÂÚ·¢ÙÈÎÔ› ÛÙfi¯ÔÈ Ù˘ ÚÒÙ˘ Ê¿Û˘
Ù˘ ıÂÚ·›·˜.
ª¤Ûˆ Ù˘ ÙÔÔı¤ÙËÛ˘ ÙˆÓ Ï·Á›ˆÓ ÙÔ̤ˆÓ ÛÙË ı¤ÛË
ÙˆÓ ÎÂÓÙÚÈÎÒÓ Î·ıÒ˜ Î·È Ù˘ ÚÔÛıÂÙÈ΋˜
·ÔηٿÛÙ·Û‹˜ ÙÔ˘˜ ÛÙȘ ηٿÏÏËϘ ‰È·ÛÙ¿ÛÂȘ, ÙÔ
ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÌÔÚ› Ó· ¯·Ú·ÎÙËÚÈÛı› ·Ô‰ÂÎÙfi
·fi ·ÈÛıËÙÈ΋˜ Î·È ÏÂÈÙÔ˘ÚÁÈ΋˜ ¿Ԅ˘.
™À∑∏∆∏™∏
∆Ô ·ÚfiÓ ¿ÚıÚÔ ÂÚÈÁÚ¿ÊÂÈ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ Ú¤ÂÈ
Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë Û ·ÛıÂÓ›˜ Ì ¤ÏÏÂÈ„Ë ‹ ÂÍ·ÁˆÁ‹
ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ÂÈϤÁÂÙ·È Ë
˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ·fi ÙÔ˘˜ Ï¿ÁÈÔ˘˜
ÙÔÌ›˜ (Czochrowska Î·È Û˘Ó., 2003). √È ÂÚÈÙÒÛÂȘ
·˘Ù¤˜
ıˆÚÔ‡ÓÙ·È
ÂÚÈÏÂÁ̤Ó˜
ÏfiÁˆ
ÙˆÓ
ıÂÚ·¢ÙÈÎÒÓ ‰˘ÛÎÔÏÈÒÓ, ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ Â·ÓÂÌÊ¿ÓÈÛ˘
‰È·ÛÙËÌ¿ÙˆÓ, Ù˘ ·˘ÍË̤Ó˘ ÊfiÚÙÈÛ˘ Ù˘ Ú›˙·˜ ÙÔ˘
Ï·Á›Ô˘ ÙÔ̤· Ô˘ ˘ÔÛÙËÚ›˙ÂÈ ÎÏÈÓÈ΋ ̇ÏË ÌÂÁ¤ıÔ˘˜
18
HELLENIC ORTHODONTIC REVIEW
In the present case, mesiodistally both the lateral
incisors were kept parallel to each other, because too
much mesial crown angulation of lateral incisors provides large gingival embrasure and sometimes black
negative space that compromise the optimum esthetics
(Schwaninger and Shaye, 1977). Also lateral incisors
were brought close to the midline and the artificial
crowns were made wider on their distal aspects.
The gingival margin of the maxillary anterior teeth must
be positioned properly for optimum esthetics (Kokich et
al., 1984; Kokich, 1993; Kokich and Spear, 1997; Kokich,
1997). In the present case maxillary lateral incisors were
moved bodily closed to the midline and gingivectomy
was performed in both the teeth for proper position of
the gingival margins of the lateral incisors. During
bracket positioning, the brackets on the canines (the socalled lateral incisors) were positioned slightly gingivally for their extrusion to bring their gingival margins
down. As the brackets were placed gingivally in the
canines, the coronal movement of the gingival margins
was less as proportional to the amount of their extrusion, and literature also suggested less coronal movement of the gingival margin than the total tooth extrusion (Pikdoken, Erkan and Usumez, 2009). Although we
took various suggested measures to match the gingival
margin levels in four incisors, but we failed to achieve at
the end. The gingival contour lines of four incisors were
almost in the same level at the end of treatment.
Although gingivectomy can be considered in the first
premolars (the so-called canines) to improve the level of
gingival margin level, however in the present case the
width of the attached gingiva was very less and thus
gingivectomy was avoided. Though there was a large
discrepancy in the level of gingival margin among six
anterior teeth, but it was still satisfactory to the patient.
The tips of canines were recontoured from the early
stage of treatment to simulate their shape to that of lateral incisors. In the final prosthesis the canines were
also further recontoured.
As the lateral incisors are small in dimension as compared to the central incisors, they need to be positioned
slightly labially and the vertical height of the crown
over them should be slightly short to avoid excessive
stress during protrusive movement of the mandible.
However in the present case, lateral incisors and canines
were included in the same prosthesis to distribute pro-
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
A
°
¢
ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· Î·È Ù˘ ‰˘ÛÎÔÏ›·˜ ÛÙËÓ ·ÈÛıËÙÈ΋
·fi‰ÔÛË (Czochrowska Î·È Û˘Ó., 2003). øÛÙfiÛÔ, Ì ÙË
ÌÂٷΛÓËÛË ÙˆÓ Ï·Á›ˆÓ ÙÔ̤ˆÓ ÛÙË ı¤ÛË ÙˆÓ ÎÂÓÙÚÈÎÒÓ
ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë Û˘Ó¤¯ÂÈ· Ù˘ Ê·ÙÓȷ΋˜ ·ÎÚÔÏÔÊ›·˜ ηÈ
‰È·ÙËÚÔ‡ÓÙ·È Ù· ÚÔÛÂÊ˘ÎfiÙ· ԇϷ Î·È ÔÈ ÌÂÛÔ‰fiÓÙȘ
ıËϤ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Û˘Ó¯È˙fiÌÂÓ˘ ·‡ÍËÛ˘ ÙÔ˘
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
B
∂ÈÎ 4. EÓ‰ÔÛÙÔÌ·ÙÈΤ˜ ʈÙÔÁڷʛ˜ ÌÂÙ¿ ÙË ıÂÚ·›· (A-E) Ô˘
·ÂÈÎÔÓ›˙Ô˘Ó ÙÔÓ ·ÚÈÛÙÂÚfi ¿Óˆ Ï¿ÁÈÔ ÙÔ̤· Î·È Î˘Ófi‰ÔÓÙ· ÛÙËÓ
ı¤ÛË ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Î·È Ï¿ÁÈÔ˘ ÙÔ̤· ·ÓÙ›ÛÙÔȯ·, Ì ·ÌÊÔÙÂÚfiÏ¢ÚË ∆¿ÍË π Û¯¤ÛË ÁÔÌÊ›ˆÓ Î·È È‰·ÓÈ΋ Û‡ÁÎÏÂÈÛË ·ÚÂȷο.
Fig. 4. Post-treatment intra-oral photographs (A-E) showing both
maxillary lateral incisors and canines in place of central and lateral
incisors respectively with bilateral Angle’s Class-I molar
relationship and proper buccal occlusion.
E
trusive stress over four teeth. In absence of canines
there is a definite impact on the canine-guided functional occlusion. Tuverson (1970) recommended posterior group function or modified group function on the
working side of the arch. In the present case, posterior
group function on the working side was achieved. The
19
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
A
∂ÈÎ. 5. E͈ÛÙÔÌ·ÙÈΤ˜ ʈÙÔÁڷʛ˜ ÌÂÙ¿ ÙË ıÂÚ·›· (A Î·È B)
Ô˘ ‰Â›¯ÓÔ˘Ó ‚ÂÏÙ›ˆÛË ÛÙÔ
ÚÔÊ›Ï ÙˆÓ Ì·Ïı·ÎÒÓ ÈÛÙÒÓ
ÙÔ˘ ·ÛıÂÓ‹.
Fig. 5. Posttreatment extra-oral
photographs (A and B) showing
improvement in the soft tissue
profile of the patient.
B
A
HELLENIC ORTHODONTIC REVIEW
B
∂ÈÎ. 6. ∂Ó‰ÔÛÙÔÌ·ÙÈΤ˜ ʈÙÔÁڷʛ˜ ÚÈÓ (∞) Î·È ÌÂÙ¿ (µ) ÙËÓ Ô˘ÏÂÎÙÔÌ‹ ÙÔ˘ ·ÔηÏÔ‡ÌÂÓÔ˘ ÎÂÓÙÚÈÎÔ‡ ÙÔ̤· ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ÔÚ›Ô˘ Ù˘
·Ú˘Ê‹˜ ÙˆÓ Ô‡ÏˆÓ.
Fig. 6. Intra-oral photographs showing before (A) and after (B) gingivectomy of the so-called central incisor for the improvement of the
gingival margin level.
ÛÙÔÌ·ÙÔÁÓ·ıÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ (Czochrowska Î·È Û˘Ó.,
2003).
™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ‰È·ÙËÚ‹ıËΠË
·Ú·ÏÏËÏfiÙËÙ· ÂÁÁ‡˜-¿ˆ ÌÂٷ͇ ÙˆÓ Ï·Á›ˆÓ ÙÔ̤ˆÓ
ÂÂȉ‹ Ë ¤ÓÙÔÓË ÚÔ˜ Ù· ÂÁÁ‡˜ ·fiÎÏÈÛË Ù˘ ̇Ï˘ ÙÔÓ›˙ÂÈ
ÙË ÌÂÛÔ‰fiÓÙÈ· Ô˘ÏÈ΋ η̿ڷ Î·È ‰ËÌÈÔ˘ÚÁ› οÔȘ
ÊÔÚ¤˜ Ì·‡Ú· ÙÚ›ÁˆÓ· (Schwaninger Î·È Shaye, 1977).
∂ÈϤÔÓ ÔÈ Ï¿ÁÈÔÈ ÙÔÌ›˜ ÌÂÙ·ÎÈÓ‹ıËÎ·Ó ÎÔÓÙ¿ ÛÙË Ì¤ÛË
20
palatal cusps of the first premolars were reduced to
eliminate any possibility of functional interference during working side lateral excursions and to prevent premature contact with the opposing teeth in centric occlusion.
The type of prosthesis depends on the age of the
patients and the periodontal health status of the lateral incisors. In the present case, the roots of the both lat-
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
A
B
°
¢
∂ÈÎ. 7. ∂Ó‰ÔÛÙÔÌ·ÙÈΤ˜ ʈÙÔÁڷʛ˜ (∞-C) Ô˘ ·ÂÈÎÔÓ›˙Ô˘Ó ÙËÓ ÌfiÓÈÌË ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË ÙˆÓ ·ÔηÏÔ‡ÌÂÓˆÓ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ
ηıÒ˜ Î·È ÙËÓ Ì›ˆÛË ÙÔ˘ ˘ÂÚÒÈÔ˘ ʇ̷ÙÔ˜ ÛÙÔ˘˜ ·ÔηÏÔ‡ÌÂÓÔ˘˜ ΢Ófi‰ÔÓÙ˜ (D).
Fig. 7. Intra-oral photographs (A-C) showing permanent restoration involving both so-called central and lateral incisors and reduction of
palatal cusp in the so-called canines (D).
ÁÚ·ÌÌ‹ Î·È Ë Ì‡ÏË ÙÔ˘˜ ‰È·ÌÔÚÊÒıËΠ¢ڇÙÂÚË ÛÙÔ
¿ˆ ÙÌ‹Ì· Ù˘.
π‰È·›ÙÂÚË ÚÔÛÔ¯‹ Ú¤ÂÈ Ó· ‰Ôı› ÛÙËÓ Î·Ù¿ÏÏËÏË
‰È·ÌfiÚʈÛË Ù˘ ·Ú˘Ê‹˜ ÙˆÓ Ô‡ÏˆÓ ÒÛÙ ӷ ˘¿ÚÍÂÈ
ÈηÓÔÔÈËÙÈÎfi ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· (Kokich Î·È Û˘Ó.,
1984; Kokich, 1993; Kokich Î·È Spear, 1997; Kokich,
1997). ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÔÈ ¿Óˆ Ï¿ÁÈÔÈ
ÙÔÌ›˜ ÌÂÙ·ÎÈÓ‹ıËÎ·Ó Ì ·Ú¿ÏÏËÏË ÌÂÙ·ÙfiÈÛË ÚÔ˜ ÙË
̤ÛË ÁÚ·ÌÌ‹ Î·È Ú·ÁÌ·ÙÔÔÈ‹ıËΠԢÏÂÎÙÔÌ‹ ÒÛÙ ӷ
ÂÍ·ÛÊ·ÏÈÛı› Ë ÛˆÛÙ‹ ı¤ÛË ÙÔ˘ ÔÚ›Ô˘ ÙˆÓ Ô‡ÏˆÓ (Pikdoken, Erkan Î·È Usumez, 2009). ∞Ó Î·È ÂÏ‹ÊıËÛ·Ó
‰È¿ÊÔÚ· ·fi Ù· ÚÔÙÂÈÓfiÌÂÓ· ̤ÙÚ· ÒÛÙ ӷ ˘¿ÚÍÂÈ
Û˘ÌÌÂÙÚ›· ÛÙËÓ ·Ú˘Ê‹ ÙˆÓ Ô‡ÏˆÓ ÙˆÓ ÙÂÛÛ¿ÚˆÓ
ÙÔ̤ˆÓ, ÙÂÏÈο ÙÔ ·ÔÙ¤ÏÂÛÌ· ‰ÂÓ ‹Ù·Ó ȉ·ÓÈÎfi. ™ÙÔ Ù¤ÏÔ˜
Ù˘ ıÂÚ·›·˜ Ë ·Ú˘Ê‹ ÙˆÓ Ô‡ÏˆÓ ÙˆÓ ÙÂÛÛ¿ÚˆÓ
ÙÔ̤ˆÓ ‹Ù·Ó ÂÚ›Ô˘ ÛÙÔ ›‰ÈÔ Â›‰Ô.
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
eral incisors were short, so both the lateral incisors and
canines were included in a single fixed prosthesis.
Although the final prosthesis was bulky, of low quality
and does not correspond to the currently existing
esthetic requirements of prosthetic restorations but it
was satisfactory to the patient and fulfilled the necessary occlusal and functional requirements.
Modifications in the fixed orthodontic appliance are
mandatory for optimum results. The present case was
treated with preadjusted edgewise appliance (Roth prescription, 0.022" slot). Maxillary lateral incisor brackets
were placed on the maxillary lateral incisors and
mandibular first premolar brackets were placed on the
maxillary canines with gingival margins facing incisally.
Maxillary canine brackets were placed on the maxillary
21
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
∞Ó Î·È Û ٤ÙÔȘ ÂÚÈÙÒÛÂȘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı›
Ô˘ÏÔÏ·ÛÙÈ΋ ÛÙÔ˘˜ ÚÒÙÔ˘˜ ÚÔÁfiÌÊÈÔ˘˜ (Ô˘
˘ÔηıÈÛÙÔ‡Ó ÙÔ˘˜ ΢Ófi‰ÔÓÙ˜) ÒÛÙ ӷ ‚ÂÏÙȈı› ÙÔ
Â›Â‰Ô ÙÔ˘ ÔÚ›Ô˘ ÙˆÓ Ô‡ÏˆÓ, ÛÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ
ÂÚÈÛÙ·ÙÈÎfi ÙÔ Â‡ÚÔ˜ ÙˆÓ ÚÔÛÂÊ˘ÎfiÙˆÓ Ô‡ÏˆÓ ‹Ù·Ó
ÂÚÈÔÚÈṲ̂ÓÔ Î·È ÁÈ’ ·˘Ùfi ÙÔ ÏfiÁÔ ·Ôʇ¯ıËΠË
Ô˘ÏÔÏ·ÛÙÈ΋. ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ˘‹Ú¯Â ÌÂÁ¿ÏË
‰˘Û·ÚÌÔÓ›· ÛÙËÓ ·Ú˘Ê‹ ÙˆÓ Ô‡ÏˆÓ ÙˆÓ ¤ÍË ÚÔÛı›ˆÓ
‰ÔÓÙÈÒÓ, Ô ·ÛıÂÓ‹˜ ‹Ù·Ó ÈηÓÔÔÈË̤ÓÔ˜ ·fi ÙÔ
·ÔÙ¤ÏÂÛÌ·. ∆· ʇ̷ٷ ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ ÙÚÔ¯›ÛÙËηÓ
‹‰Ë ·fi Ù· ·Ú¯Èο ÛÙ¿‰È· Ù˘ ıÂÚ·›·˜ ÒÛÙ ӷ
ÚÔÛÔÌÔÈ¿˙Ô˘Ó Ì Ï¿ÁÈÔ˘˜ ÙÔÌ›˜. ∫·Ù¿ ÙËÓ ÙÂÏÈ΋
·ÔηٿÛÙ·ÛË ·ÎÔÏÔ‡ıËÛ ÂÈϤÔÓ ÂÎÙÚÔ¯ÈÛÌfi˜.
∂Âȉ‹ ÔÈ Ï¿ÁÈÔÈ ÙÔÌ›˜ Â›Ó·È ÌÈÎÚfiÙÂÚÔÈ Û ‰È·ÛÙ¿ÛÂȘ
·fi ÙÔ˘˜ ÎÂÓÙÚÈÎÔ‡˜, Ú¤ÂÈ Ó· ÙÔÔıÂÙËıÔ‡Ó ÂÏ·ÊÚÒ˜
¯ÂÈÏÈο Î·È ÙÔ Î·Ù·ÎfiÚ˘ÊÔ ‡„Ô˜ Ù˘ ̇Ï˘ ÙÔ˘˜ Ú¤ÂÈ Ó·
Â›Ó·È ÂÏ·ÊÚÒ˜ ÎÔÓÙ‡ÙÂÚÔ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› Ë
˘ÂÚ‚ÔÏÈ΋ ÊfiÚÙÈÛË Î·Ù¿ ÙËÓ ÚÔÔÏ›ÛıËÛË Ù˘ οو
ÁÓ¿ıÔ˘. øÛÙfiÛÔ ÛÙÔÓ ·ÚfiÓ ÂÚÈÛÙ·ÙÈÎfi ÔÈ Ï¿ÁÈÔÈ ÙÔÌ›˜
Ó·ÚıËÎÔÔÈ‹ıËÎ·Ó Ì·˙› Ì ÙÔ˘˜ ΢Ófi‰ÔÓÙ˜ Û ÂÓÈ·›·
ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË ÒÛÙ ÙÔ ÊÔÚÙ›Ô Ó·
ηٷӤÌÂÓÙ·È Î·È ÛÙ· Ù¤ÛÛÂÚ· ‰fiÓÙÈ·. §fiÁˆ Ù˘ ·Ô˘Û›·˜
ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ ˘¿Ú¯ÂÈ ÚÔÊ·ÓÒ˜ ·‰˘Ó·Ì›· Â›Ù¢Í˘
Û˘ÁÎÏÂÈÛÈ·ÎÔ‡ Û¯‹Ì·ÙÔ˜ ΢ÓÔ‰ÔÓÙÈ΋˜ ÚÔÛÙ·Û›·˜. √
Tuverson (1970) ÚfiÙÂÈÓ ÙË ‰ËÌÈÔ˘ÚÁ›· Û˘ÁÎÏÂÈÛÈ·ÎÔ‡
Û¯‹Ì·ÙÔ˜ Ô›ÛıÈ·˜ ÔÌ·‰È΋˜ ‹ ÙÚÔÔÔÈË̤Ó˘ ÔÌ·‰È΋˜
ÚÔÛÙ·Û›·˜ ÛÙËÓ ÂÚÁ·˙fiÌÂÓË ÏÂ˘Ú¿. ∆· ˘ÂÚÒÈ·
ʇ̷ٷ ÙˆÓ ÚÒÙˆÓ ÚÔÁÔÌÊ›ˆÓ ÙÚÔ¯›ÛÙËÎ·Ó ÒÛÙ ӷ
ÂÚÈÔÚÈÛÙ› Ë Èı·ÓfiÙËÙ· ÏÂÈÙÔ˘ÚÁÈÎÒÓ ·ÚÂÌ‚ÔÏÒÓ ÛÙËÓ
ÂÚÁ·˙fiÌÂÓË ÏÂ˘Ú¿ ηٿ ÙȘ Ï¿ÁȘ ÎÈÓ‹ÛÂȘ ηÈ
ÚfiˆÚˆÓ Â·ÊÒÓ Ì ÙÔ˘˜ ·ÓÙ·ÁˆÓÈÛÙ¤˜ Û ÎÂÓÙÚÈ΋
Û‡ÁÎÏÂÈÛË.
√ Ù‡Ô˜ Ù˘ ·ÔηٿÛÙ·Û˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘
·ÛıÂÓÔ‡˜ Î·È ·fi ÙËÓ ÂÚÈÔ‰ÔÓÙÈ΋ ηٿÛÙ·ÛË ÛÙËÓ
ÂÚÈÔ¯‹ ÙˆÓ Ï·ÁÈÒÓ ÙÔ̤ˆÓ. ™ÙËÓ ·ÚÔ‡Û· ÂÚ›ÙˆÛË
ÂÂȉ‹ ÔÈ Ú›˙˜ ÙˆÓ Ï·Á›ˆÓ ÙÔ̤ˆÓ ‹Ù·Ó ÎÔÓÙ¤˜
·ÔÊ·Û›ÛÙËÎÂ Ë Ó·ÚıËÎÔÔ›ËÛË ÙˆÓ ‰‡Ô Ï·Á›ˆÓ
ÙÔ̤ˆÓ Î·È ÙˆÓ Î˘ÓÔ‰fiÓÙˆÓ Û ÂÓÈ·›· ·Î›ÓËÙË
ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË. ∞Ó Î·È Ë ÙÂÏÈ΋ ÚÔÛıÂÙÈ΋
·ÔηٿÛÙ·ÛË ‹Ù·Ó ÔÁÎ҉˘ Î·È ‰ÂÓ ÈηÓÔÔÈÔ‡Û ٷ
ÔÈÔÙÈΤ˜ Î·È ·ÈÛıËÙÈΤ˜ ··ÈÙ‹ÛÂȘ Ù˘ ÂÔ¯‹˜, Ô ·ÛıÂÓ‹˜
‹Ù·Ó ÈηÓÔÔÈË̤ÓÔ˜ ·fi ÙÔ ·ÔÙ¤ÏÂÛÌ· Î·È Ë
·ÔηٿÛÙ·ÛË ÏËÚÔ‡Û ٷ Û˘ÁÎÏÂÈÛȷο ηÈ
ÏÂÈÙÔ˘ÚÁÈο ÎÚÈÙ‹ÚÈ·.
°È· ÙÔ ‚¤ÏÙÈÛÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ ıÂÚ·›·˜ ›ӷÈ
··Ú·›ÙËÙ˜ οÔȘ ÙÚÔÔÔÈ‹ÛÂȘ ÛÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜
Ì˯·ÓÈÛÌÔ‡˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È. ∏ ·ÚÔ‡Û·
ÂÚ›ÙˆÛË
ıÂÚ·‡ÙËÎÂ
ÌÂ
¯Ú‹ÛË
ÚÔ-
22
HELLENIC ORTHODONTIC REVIEW
first premolars. However depending on the requirement, necessary in and out, tip and torque were incorporated in the finishing archwire to achieve optimum
1st, 2nd and 3rd order positions of individual tooth.
Mild canine eminence was given for first premolars and
proper arch form was achieved. Thus individualization of
the orthodontic appliance is mandatory for optimum
result.
CONCLUSION
Replacement of maxillary central incisors by lateral
incisors is a clinical challenge to the orthodontists. The
clinical results of replacing both maxillary central
incisors with mesially moved lateral incisors were satisfactory to the patient. Individualization of the orthodontic appliance and proper periodontal and restorative
procedures are required for optimum result. Various
issues discussed in this article will definitely provide
some helpful guidelines to orthodontists for managing
patients with replacement of maxillary central incisors
by lateral incisors.
References
Asher C, Lewis DH. The integration of orthodontic and restorative
procedures in cases with missing maxillary incisors. Br Dent J
1986;160:241-45.
Czochrowska EM, Stenvik A, Bjercke B, Zachrisson BU. Outcome of
tooth transplantation: survival and success rates 17-41 years
posttreatment. Am J Orthod Dentofacial Orthop 2002;121:11019.
Czochrowska EM, Skaare AB, Stenvik Arild, Zachrisson BU. Outcome of orthodontic space closure with a missing maxillary
central incisor. Am J Orthod Dentofacial Orthop 2003;123:597603.
Edwards JG. The diastema, the frenum, the frenectomy: A clinical
study. Am J Orthod 1977;71:489-508.
Gazit E, Lieberman MA. Macrodontia of maxillary central incisors:
case reports. Quintessence Int 1991;22:883-87.
Hellekant M, Twetman S, Carlsson L. Treatment of a Class-II Division 1 malocclusion with macrodontia of the maxillary central
incisors. Am J Orthod Dentofacial Orthop 2001;119:654-59.
Henn S. The canine eminence. Angle Orthod 1974;44:326-28.
Kokich V, Nappen D, Shapiro P. Gingival contour and clinical crown
length: their effects on the esthetic appearance of maxillary
anterior teeth. Am J Orthod 1984;86:89-94.
Kokich V. Anterior dental esthetics: an orthodontic perspective I.
Crown length. J Esthet Dent 1993;5:19-23.
Kokich VG, Spear F. Guidelines for managing the orthodonticrestorative patient. Semin Orthod 1997;3:3-20.
Kokich VG. Esthetics and vertical tooth position: the orthodontic
HELLENIC ORTHODONTIC REVIEW 2010 ñ VOLUME 13 ñ ISSUE 1 & 2
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H
√ÚıÔ‰ÔÓÙÈ΋ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ / Orthodontic replacement of maxillary central incisors
ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ edgewise (Roth prescrisption 0.022å slot). ™ÙÔ˘˜ ¿Óˆ Ï¿ÁÈÔ˘˜ ÙÔÌ›˜
ÙÔÔıÂÙ‹ıËÎ·Ó ÔÚıÔ‰ÔÓÙÈο ·Á·ÏÈ· Î·È ÙÔ˘˜
΢Ófi‰ÔÓÙ˜ ÙÔÔıÂÙ‹ıËÎ·Ó ·Á·ÏÈ· οو ÚÔÁÔÌÊ›Ô˘
Ì ٷ Ô˘ÏÈο ÙÂÚ‡ÁÈ· Ó· ÎÔÈÙ¿˙Ô˘Ó ÎÔÙÈο. ™ÙÔ˘˜
ÚÒÙÔ˘˜ ÚÔÁfiÌÊÈÔ˘˜ ·Ô‰fiıËΠ‹È· ηÌ˘ÏfiÙËÙ·
΢ÓÔ‰ÔÓÙÈÎÔ‡ Â¿ÚÌ·ÙÔ˜ ÒÛÙ ӷ ‰ËÌÈÔ˘ÚÁËı›
ηٿÏÏËÏÔ Û¯‹Ì· ÛÙÔ ÙfiÍÔ. ∏ ¯Ú‹ÛË ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓÔ˘
Û˘ÛÙ‹Ì·ÙÔ˜ ÔÚıÔ‰ÔÓÙÈÎÒÓ Ì˯·ÓÈÛÌÒÓ Â›Ó·È ··Ú·›ÙËÙË
ÁÈ· ÙÔ Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ·.
™Àª¶∂ƒ∞™ª∞∆∞
∏ ˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ ·fi ÙÔ˘˜
Ï·Á›Ô˘˜ ·ÔÙÂÏ› ÚfiÎÏËÛË ·fi ıÂÚ·¢ÙÈ΋˜ ÏÂ˘Ú¿˜
ÁÈ· ÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜. ™ÙÔ ÂÚÈÛÙ·ÙÈÎfi Ô˘
ÂÚÈÁÚ¿ÊËΠٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ ÚÔ˜ Ù· ÂÁÁ‡˜
ÌÂٷΛÓËÛ˘ ÙˆÓ ¿Óˆ Ï·Á›ˆÓ ÙÔ̤ˆÓ ÁÈ· Ó·
˘ÔηٷÛÙ‹ÛÔ˘Ó ÙÔ˘˜ ÎÂÓÙÚÈÎÔ‡˜ ‹Ù·Ó ÈηÓÔÔÈËÙÈο. ∏
ÂÍ·ÙƠ̂΢ÛË ÙˆÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Û˘Û΢ÒÓ Î·È ÔÈ
ηٿÏÏËϘ ÂÚÈÔ‰ÔÓÙÈΤ˜ Î·È ÚÔÛıÂÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ
Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙÔ Î·Ï‡ÙÂÚÔ ·ÔÙ¤ÏÂÛÌ·. ∆·
˙ËÙ‹Ì·Ù· Ô˘ Û˘˙ËÙÔ‡ÓÙ·È Û ·˘Ùfi ÙÔ ¿ÚıÚÔ ·Ú¤¯Ô˘Ó
¯Ú‹ÛÈ̘ Ô‰ËÁ›Â˜ ÛÙÔ˘˜ ÔÚıÔ‰ÔÓÙÈÎÔ‡˜ ÁÈ· ÙËÓ
·ÓÙÈÌÂÙÒÈÛË ÂÚÈÛÙ·ÙÈÎÒÓ fiÔ˘ ÂÈϤÁÂÙ·È Ë
˘ÔηٿÛÙ·ÛË ÙˆÓ ¿Óˆ ÎÂÓÙÚÈÎÒÓ ÙÔ̤ˆÓ ·fi ÙÔ˘˜
Ï·Á›Ô˘˜.
possibilities. Compendium Cont Ed Dent 1997;18:1225-31.
Kokich VG, Crabill KE. Managing the patient with missing or malformed maxillary central incisors. Am J Orthod Dentofacial
Orthop 2006;129 (Supl-1):S55-S63.
Kramer P, Horst S, Konig J, Reston E, Ernani C. Rehabilitative treatment after unsuccessful teeth replantation: a case report. J Clin
Pediatr Dent 2002;26:119-24.
Lin YTJ. Treatment of an impacted dilacerated maxillary central
incisor. Am J Orthod Dentofacial Orthop 1999;115:406-9.
McNeill R, Joondeph DR. Congenitally absent maxillary lateral
incisors. Treatment planning considerations. Angle Orthod
1973;43:24-29.
Monefeldt I, Zachrisson BU. Adjustment of clinical crown height by
gingivectomy following orthodontic space closure Angle
Orthod 1977;47:256-64.
Ngan DC, Kharbanda OP, Darendeliler MA. Considerations in the
management of transposed teeth. Aust Orthod J 2004;20:4150.
Pikdoken L, Erkan M, Usumez S. Gingival response to mandibular
incisor extrusion. Am J Orthod Dentofacial Orthop
2009;135:432-433
Schwaninger B, Shaye R. Management of cases with upper incisor
missing. Am J Orthod 1977;71:396-405.
Slagsvold O, Bjercke B. Applicability of autotransplantation in
cases of missing anterior teeth. Am J Orthod 1978;74:410-21.
Trope M. Avulsion and replantation. Refuat Hapeh Vehashinayim
2002;19:6-15.
Tuverson DL. Orthodontic treatment using canines in place of missing maxillary lateral incisors. Am J Orthod 1970;58:109-27.
Zachrisson BU. Clinical experience with direct bonded orthodontic
retainers. Am J Orthod 1977;71:440-448.
Zachrisson BJ. Improving orthodontic results in cases with maxillary
incisor missing. Am J Orthod 1978;73:274-89.
¢È‡ı˘ÓÛË ÁÈ· ·Ó¿Ù˘·:
Reprint requests to:
Dr. Ashok Kumar Jena
Assistant Professor
Unit of Orthodontics
Oral Health Sciences Centre
Postgraduate Institute of Medical Education
and Research
Sector-12, Chandigarh-160012,
India
E-mail: [email protected]
E§§HNIKH OP£O¢ONTIKH E¶I£EøPH™H 2010 ñ TOMO™ 13 ñ TEYXO™ 1 & 2
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