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Simultaneous Bilateral Intrusion of Supra-Erupted Maxillary Molars using Miniscrew Implants Aneesha A Shetty Adarsh S Shetty Roopak D Naik Anand K Patil Dental Update 2024 12:1, 707-709.
Authors
Aneesha AShetty
BDS, Postgraduate Student
Department of Orthodontics and Dentofacial Orthopedics, SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India
Reader, Department of Orthodontics and Dentofacial Orthopaedics, SDM College of Dental Sciences and Hospital, Sattur, Dharwad – 580 009 Karnataka, India
The loss of lower molars often leads to over-eruption of the opposing maxillary molars, combined with insufficient clearance for lower prosthetic restorations. The available treatment options are either a significant reduction of the maxillary teeth, often associated with endodontic treatment, or removable appliances such as headgear which depend on patient compliance; a complex fixed orthodontic treatment, which may involve unwanted side-effects, or a segmental impaction involving all the risks of surgery and patient discomfort. In previous years, different cases of orthodontic intrusion with miniscrew implants have been described, which make use of four or more miniscrews for bilateral maxillary molar intrusion. In this report, a case is presented requiring bilateral maxillary molar intrusion in order to get sufficient space for an implant-supported fixed restoration in the lower posterior region. This intrusion was carried out simultaneously on both sides by means of three miniscrew implants and a customized transpalatal arch. The results showed significant intrusion of the supra-erupted maxillary molars with normal and acceptable biological response of the teeth and the surrounding bony structures.
CPD/Clinical Relevance: This paper presents a case report demonstrating a new clinical technique to intrude supra-erupted maxillary molars simultaneously on both sides with the use of three miniscrew implants instead of the conventional four, and a customized transpalatal arch which is simple to fabricate. The technique shows effective results in terms of intrusion achieved and the absence of clinically detectable apical root resorption of the intruded molars.
Article
Overeruption of maxillary molars usually results from early loss of antagonistic teeth. This may cause problems of occlusal interferences and functional disturbances and may result in great difficulty during prosthetic reconstruction. Generally, several conventional options are available to increase occlusal clearance. Norton and Lopes reported that grinding of the extrusive molar before full coverage prosthesis was the treatment of choice because intrusion of the overerupted teeth was difficult and problematic.1 However, such occlusal reduction requires endodontic intervention and crown restoration at the expense of tooth vitality. Another alternative method proposed by Schoeman and Subramanian is a posterior segmental osteotomy of the maxilla to impact the elongated segment,2 but patients must undergo the risk of general anaesthesia and high cost associated with this procedure. To intrude overerupted maxillary molars by conventional orthodontic means, anchorage can be prepared by incorporating multiunit teeth and adding extra-oral headgear wear. High-pull headgear may achieve intrusion of maxillary posteriors, but the treatment result depends heavily on patient compliance, and is especially not preferred by adults.
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