Abstract
Abstract Introduction Of the types of dental trauma, intrusive luxation is considered to have the worst prognosis. When forceful intrusion affects multiple adjacent teeth, orthodontic repositioning may be required; however, orthodontic treatment can be complicated by the development of a cant in the occlusal plane, especially when the affected teeth are not symmetrically located from the midline and corrective forces and anchorage are unbalanced. Designing an appropriate mechanism to overcome this problem is essential. Case presentation The present case report describes a 28-year-old male who suffered the traumatic intrusion of multiple teeth, with accompanying alveolar bone fractures, following a road traffic accident. The intruded teeth were repositioned using orthodontic traction, following which, endodontic treatment was performed. After initial alignment, differential curve of Spee mechanics were applied to correct the occlusal plane and an acceptable result was achieved. The overall outcome was maintained at a 24-months review. Conclusion This report demonstrates the importance of the early repositioning of intruded teeth to avoid dento-alveolar ankylosis, as well as the use of differential curve of Spee mechanics which provides effective force application in the management of a canted occlusal plane.
Highlights
Of the types of dental trauma, intrusive luxation is considered to have the worst prognosis
When facing severe trauma involving dental displacement and alveolar bone fractures, clinicians are often concerned about complications such as pulp canal obliteration, pulp necrosis, root resorption, dento-alveolar ankylosis, and marginal bone loss
The rapid movement may possibly be ascribed to a regional acceleratory phenomenon (RAP), which is a local response of tissues to noxious events that subsequently stimulates tissue to regenerate faster than normal in a regional regeneration/remodelling process.[25]
Summary
Dental trauma is a complicated issue faced in dental practice because many treatment disciplines are often involved. Several management approaches may be considered for patients with traumatised intruded teeth and alveolar bone fractures, including no treatment (spontaneous re-eruption), orthodontic extrusion, surgical repositioning, or a combination of the above. The present case report details the use of a reverse and asymmetrical intra-arch force couple called ‘differential curve of Spee mechanics’ to correct an occlusal plane cant after dental repositioning. An intraoral assessment showed multiple severely intruded teeth in the lower right quadrant (Figure 1d-h). During treatment, applying inter-arch elastics for dental extrusion was considered This would largely rely on patient compliance and would potentially cause an occlusal cant in the upper arch.[10,16,17] a reverse and asymmetrical intra-arch force couple delivered by a differential curve of Spee mechanic was developed for the occlusal plane correction. The EPT readings were higher than the initial status, it was decided to regularly review these teeth
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