Orthodontic - surgical treatment of unerupted permanent teeth using the fully repositioned flap technique . Part 1 . Results , treatment time and post - treatment stability in 90 cases

Aim The aim of this study was to investigate the surgical and orthodontic findings of combined orthodontic-surgical management of unerupted permanent teeth performed by the same team in one clinic and using the same fully repositioned flap as the surgical technique for tooth exposure. Methods This was a retrospective study using patients’ records, orthopantomographs and lateral cephalographs. From these records, the age, position of the impacted tooth, type of orthodontic anomaly, surgical and orthodontic treatment performed, duration and the orthodontic status after four years were recorded for each patient. The sample included 68 individuals aged 9-25 years, who received treatment in 68 maxillary and mandibular canines, 17 maxillary and mandibular incisors, four mandibular premolars and one mandibular molar. From the 90 teeth in total, 60 were positioned buccally and 30 palatally (all maxillary canines), while 79 were in the maxilla and 11 in the mandible. The surgical procedure used was the one-step fully repositioned flap including attachment of a bracket with a ligature wire using acid-etch technique, followed by orthodontic traction introduced always from the same jaw upon necessary space creation. The four-year follow-up reexamination of 48 patients, treated for unilateral exposure, included occlusal evaluation in the operated and the control teeth in the opposite side. Results In 86 teeth (95.5% of the total cases) the treatment was successful. In seven cases (7.7%) a second operation was needed because of wire or bracket failure during orthodontic traction. In further 12 cases (13.3%) a second step crown uncovering was performed after the tooth's eruption, as a result of local gingival overgrowth. Mean eruption time in successful cases was 8.6 months (range 4-20 months). Statistical analysis of the data revealed that buccally positioned canines erupted quicker (x=7.9 months) than the palatal ones (x=11.4 months), whereas there was no statistically significant difference in eruption time among the buccally positioned canines and incisors. Eruption time was statistical significantly related in the cases of buccal canines with both the height and the angle of the impacted teeth, while in cases of palatal canines only with angle. In the cases of the buccally positioned incisors height was more relevant to the eruption time than angulation. Concerning their orthodontic status, 38 (79.1%) of the patients presented acceptable alignment on the impaction side as compared with 46 (95.8%) in the control side.This difference was statistically significant. Conclusions The results of this study indicate that the orthodontic-surgical treatment of unerupted teeth using the fully repositioned flap is a successful procedure and should be considered as a treatment of first choice in such cases. Possible future orthodontic problems may exist, but they can be resolved with proper clinical handling.