Erfolgreiche kieferorthopädische Einstellung eines dilazerierten oberen mittleren Inzisivus – ein Fallbericht

Zusammenfassung

Hintergrund Verlagerte, dilazerierte Inzisiven sind häufig Folge eines dentalen Traumas im Milchgebiss. Aufgrund z.T. erheblicher funktionell-ästhetischer Einschränkungen ist eine adäquate Therapie indiziert, die neben einer Extraktion mit Lückenschluss, (implantat)prothetischer Versorgung oder Autotransplantation bleibender Zahnkeime auch in einer kombiniert chirurgisch-kieferorthopädischen Einstellung in den Zahnbogen bestehen kann.

Fallvorstellung Bei einem 9-jährigen Patienten mit dilazeriertem Zahn 21, Mesialstand der Seitenzähne im 2. Quadranten sowie tiefem Überbiss mit traumatischem Einbiss der unteren Inzisiven erfolgte im Rahmen einer festsitzenden kieferorthopädischen Multibrackettherapie eine Einstellung des Zahnes 21 in Okklusion nach chirurgischer Freilegung und Traktion mittels des EWC-Systems (Adenta), skelettal verankert über 2 temporäre mediane palatinale Minischrauben an einer BENEslider-Apparatur (PSM Medical Solutions), welche zudem zur Molarendistalisation im 2. Quadranten genutzt wurde.

Schlussfolgerungen Im Fallbericht konnte unter Anwendung einer skelettalen Verankerung und des EWC-Systems im frühen Wechselgebiss ein dilazerierter mittlerer oberer Schneidezahn erfolgreich kieferorthopädisch unter Erhaltung der Zahnvitalität eingestellt werden. Trotz möglicher Risiken (Devitalisierung, Zahnwurzelresorptionen, Ankylosierung) stellt dieses Vorgehen daher bei korrekter biomechanischer Planung eine mögliche zahnerhaltende Therapieoption dar.

Abstract

Background Displaced, dilacerated incisors are often the result of dental trauma in the deciduous dentition. Due to sometimes considerable functional and aesthetic limitations, adequate therapy is indicated, which can consist of extraction therapy with gap closure, (implant-)prosthetic restoration or autotransplantation of permanent tooth germs as well as a combined surgical and orthodontic alignment of the dilacerated incisor in the dental arch.

Case presentation In a 9-year-old patient with dilacerated tooth 21, mesial movement of posterior teeth in the 2nd quadrant, and deep overbite with traumatic occlusion of lower incisors, fixed orthodontic multibracket therapy with orthodontic alignment of tooth 21 into occlusion was performed after surgical exposure and traction using the EWC system (Adenta) in combination with skeletal anchorage via 2 temporary median palatinal miniscrews and a BENEslider appliance (PSM Medical Solutions), which was also used for molar distalization in the 2^nd quadrant.

Conclusions In this case report, using skeletal anchorage and the EWC system in the early mixed dentition, a dilacerated upper central incisor could be successfully aligned orthodontically, while preserving dental vitality. Despite possible risks (devitalization, root resorption, ankylosis), this procedure therefore represents a viable, tooth-preserving therapy option in case of correct biomechanical planning.

Schlüsselwörter

Dilazeration - Verlagerung - dentales Trauma - skelettale Verankerung - EWC-System

Key words

dilaceration - impaction - dental trauma - skeletal anchorage - EWC system

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