Читать книгу Orthodontic Treatment of Impacted Teeth - Adrian Becker - Страница 93

It must be recognized that, other than transplantation, there are no surgical methods by which an impacted tooth may be positively and actively aligned. The best that surgery can do is to provide the optimal environment for normal and unhindered eruption and then live in hope that the tooth will oblige. In consequence, the recommendation in the latter part of the twentieth century was that those teeth that the oral surgeon considered worth trying to recover were widely exposed and packed with some form of surgical or periodontal pack, in order to protect the wound during the healing phase and prevent re‐healing of the tissues over the tooth. The expectation was that the tooth would erupt spontaneously and could then be aligned with orthodontic treatment. Several other steps were often taken, depending on the individual preferences and beliefs of the surgeon, with the aim of providing that ‘extra something’ that would further improve the chances of spontaneous eruption. These measures were frequently empirical in nature and would include one or more of the following:

 Eliminating the follicular sac completely, down to the cemento‐enamel junction (CEJ) area.

 Removing all bone around the tooth, down to the CEJ area, in order to dissect out and free the entire crown up to the coronal portion of the root of the impacted tooth.

 ‘Loosening’ the tooth by luxating it with an elevator or extraction forceps.

 Bone channelling in the direction of the desired movement of the tooth.

 Packing gauze or heat‐softened gutta percha into the area of the CEJ, under pressure, in order to apply force to deflect the eruption path of the tooth in the preferred direction.

Back in the early 1970s, it was rare that the general dentist referred such patients to the orthodontist, at least not before full eruption had been achieved and then only to assist in moving the tooth horizontally into line with its neighbours. Before full eruption took place, the problem was considered to be within the realm of the oral surgeon. In many cases, ‘success’ in achieving the eruption of the tooth was indeed pyrrhic and sometimes actually caused a greater problem, particularly in relation to the periodontal condition of the newly erupted tooth and its survival potential – namely, its prognosis. This most unfortunate consequence was the result of the aggressive and overenthusiastic surgical techniques that were then being used, most of which typically left the tooth with an unaesthetic and elongated clinical crown, a lack of attached gingiva and a reduced alveolar crest height [9–13]. Just occasionally, these damaging procedures initiated an invasive cervical root resorption lesion, which created a state of non‐response to orthodontic traction and failure in generating its eruption.