Читать книгу Orthodontic Treatment of Impacted Teeth - Adrian Becker - Страница 100

In Chapter 11 we shall demonstrate in greater detail that infra‐occluded permanent teeth are sometimes ankylosed to the surrounding bone and will consequently not respond to orthodontic traction. For the purposes of this present chapter, it should be briefly noted that the ankylosed area of the root is often minimal and may easily be detached by deliberate, but gentle, luxation of the tooth. This will normally be carried out using an elevator or extraction forceps and is done in such a way as to release the rigid and inflexible connection of the bony union. The aim is neither to remove the tooth from its socket nor even to tear the periodontal fibres (which is inevitable). The purpose is to bring the tooth to a greater than normal degree of mobility.

A frequent and undesired consequence of this procedure is a re‐healing and re‐attachment of the tooth to its former ankylotic connection. Accordingly, this approach can only be successful if the traction force is applied to the tooth immediately upon luxation and maintained continuously active. The re‐healing of the bone will be modified by a localized microcosm of distraction osteogenesis [17, 18] created by the traction process. It follows that if the traction force is allowed to decay to ineffectiveness (between patients’ visits for adjustments), re‐ankylosis will result and the tooth will stop moving. Accordingly, in order to be effective, the traction must be of sufficient magnitude and range to cause distraction and to remain active between one visit for adjustment and the next.