Ankylosed maxillary incisor with severe root resorption treated with a single-tooth dento- osseous osteotomy, vertical alveolar distraction osteogenesis,

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Ankylosed maxillary incisor with severe root resorption treated with a single-tooth dento- osseous osteotomy, vertical alveolar distraction osteogenesis, and mini-implant anchorage Neslihan Ebru Şenışık, Gülperi Koçer, Bulem Üreyen Kaya American Journal of Orthodontics and Dentofacial Orthopedics Volume 146, Issue 3, Pages 371-384 (September 2014) DOI: 10.1016/j.ajodo.2013.10.026 Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 1 Pretreatment facial and intraoral photographs. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 2 Pretreatment dental casts. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 3 Pretreatment radiographs and cephalometric tracing. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 4 Ankylosed tooth retreatment with MTA. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 5 Presurgical facial and intraoral photographs. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 6 Presurgical dental casts. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 7 Presurgical radiographs and cephalometric tracing. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 8 Surgical procedure: A, full-thickness mucoperiosteal flap was reflected; B, a single-tooth dento-osseous osteotomy was performed; C, osteotomy cuts were deepened with a microsagittal saw; D, the bone-block unit was controlled and mobilized; E, the self-tapping mini-implant was placed in the center of the ankylosed tooth-supporting bone; F, the mucoperiosteal flap was closed and sutured. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 9 Alveolar distraction process with intraoral elastics and mini-implant anchorage: A, before surgery and distraction; B, resultant force vector applied during process; C, after 1 week; D, black lines show force application points on mandibular arch and intraoral elastic wear; E, after 15 days of distraction, the bracket was bonded to the ankylosed tooth and tied onto the 0.016 × 0.022-in nickel-titanium archwire; F, intraoral anterior box elastics without the maxillary right central incisor were used to maintain the result. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 10 Force vectors and moments during the distraction phase. Blue line, beginning of distraction phase; light blue line, before ligation; red line, beginning of consolidation phase. A, Distraction phase in the sagittal plane; direction of resultant force vector (F) and its components (Fx, Fy) applied to the bone block with elastics. Moment of resultant force caused clockwise rotation. B, Distraction phase in the sagittal plane; rotation of the bone block and the maxillary right central incisor in a counterclockwise direction caused by the ligation force. C, Distraction phase with elastics in the vertical plane, and direction of resultant force vector (F) and its components (Fx, Fy) applied to the bone block with elastics. The moment of resultant force caused a counterclockwise rotation. D, After ligation in the vertical plane, rotation of the bone block and the maxillary right central incisor in a clockwise direction was caused by the ligation force. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 11 Radiographs of the alveolar distraction process: A1, before dento-osseous osteotomy; mini-implant placement was controlled after insertion with orthopantomogram; A2, peripapical radiograph; B1, after dento-osseous osteotomy; root resorption of the ankylosed tooth was checked 1 month after the end of the distraction period with orthopantomogram; B2, periapical radiograph. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 12 Postsurgical facial and intraoral photographs. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 13 Postsurgical dental casts. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 14 Postsurgical radiographs and cephalometric tracing. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions

Fig 15 Superimposed cephalometric tracings. Black line, pretreatment; blue line, presurgical; red line, posttreatment. A, Cranial base superimposition; B, maxillary regional superimposition; C, mandibular regional superimposition. Cranial base and mandibular regional superimpositions were made according to the method of Bjork and Skieller.35 Maxillary regional superimposition was performed on the palatal plane at the posterior nasal spine. American Journal of Orthodontics and Dentofacial Orthopedics 2014 146, 371-384DOI: (10.1016/j.ajodo.2013.10.026) Copyright © 2014 American Association of Orthodontists Terms and Conditions