case_images: PMC4470929_01
case_images: Initial clinical examination of a frontal view, b right lateral view, c left lateral view, d maxillary occlusal view, and e mandibular occlusal view
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case_images: Fig1
case_images: Both maxillary and mandibular right second primary molars were present while all other primary teeth had exfoliated (Fig. 1). Cephalometric analysis showed a skeletal class I relationship and hyperdivergent skeletal pattern (Fig. 2b, Table 1). Cephalometric analysis showed that the mandibular incisors did not experience lingual movement as a result of molar protraction (Fig. 9b, Table 1).
case_images: a Panoramic radiograph showing congenitally missing right 2nd premolars. b Cephalometric radiograph at the start of treatment
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case_images: Fig2
case_images: Radiographic examination revealed congenitally missing right second premolars and all third molars (Fig. 2a). Cephalometric analysis showed a skeletal class I relationship and hyperdivergent skeletal pattern (Fig. 2b, Table 1).
case_images: Induced ankylosis technique a extraoral root canal treatment of the mesial root of the primary tooth, b hemisectomy of the primary tooth, and c replantation of the mesial part and splinting
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case_images: Fig3
case_images: The ankylosis technique included extraction of the primary molar under local anesthesia followed by root canal treatment of the mesial root, performed ex vivo using a zinc oxide and eugenol sealer (Fig. 3a). The crown was then restored with composite resin and a 2-mm apicoectomy and hemisectomy of the tooth was performed (Fig. 3b). To stabilize the tooth and assure ankylosis, a rigid splint was applied, extending from the right canine to the right first molar, using a 0.016'' x 0.022'' stainless steel (SS) rectangular wire (Fig. 3c).
case_images: Radiograph 10 weeks post replantation showing the absence of periodontal ligament and root ankylosis
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case_images: Fig4
case_images: Ankylosis of the mesial root of the primary mandibular right second molar was diagnosed after 10 weeks through clinical and radiographic examination, and the splint was removed (Fig. 4).
case_images: Initial orthodontic space closure using a T-loop to close the space between the primary molar segment and the permanent first molar
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case_images: Fig5
case_images: T-loop 0.017'' x 0.025'' TMA sectional wire was inserted between the permanent and primary molar, without any prior levelling, to move the permanent first molar mesially (Fig. 5). The T-loop was activated 9 times.
case_images: Radiograph 6 months post replantation showing almost total root resorption and complete space closure between the 1st permanent molar and 2nd primary molar
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case_images: Fig6
case_images: At 6 months, clinical and radiographic examination revealed almost total replacement resorption of the root of the primary tooth and complete closure of the space (Fig. 6).
case_images: Orthodontic space closure using a retraction elastic chain to close the space between the permanent first molar and the first premolar; a stop was added to the wire to maximize anchorage
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case_images: Fig7
case_images: Remaining space closure was performed, during the next year, using elastic chain on a 0.017'' x 0.025'' SS wire with tip-back (Fig. 7) and support from class II elastics.
case_images: Clinical examination after the completion of orthodontic treatment showing the 1st permanent molar in the position of the 2nd premolar a frontal view, b right lateral view, c left lateral view, d maxillary occlusal view, and e mandibular occlusal view
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case_images: Fig8
case_images: Final records show class I canine and molar relationship on both sides; full space closure of the agenesis sites, confirmed with the use of dental floss; and correction of overbite and overjet; however, a slight midline deviation remained (Figs. 8 and 9a).
case_images: a Panoramic radiograph at the end of orthodontic treatment showing the 1st permanent molar in the position of the 2nd premolar. b Final cephalometric radiograph
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case_images: Fig9
case_images: Final records show class I canine and molar relationship on both sides; full space closure of the agenesis sites, confirmed with the use of dental floss; and correction of overbite and overjet; however, a slight midline deviation remained (Figs. 8 and 9a). Cephalometric analysis showed that the mandibular incisors did not experience lingual movement as a result of molar protraction (Fig. 9b, Table 1).