Journal of Clinical Orthodonics

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A Lesson Learned

PHILIP MATTHEW NISCO DDS

An 11-year-old female presented for orthodontic treatment. The records were unremarkable save for one thing: the panoramic x-ray showed an extraordinarily wide span from the distal of the mandibular right first molar to the mesial of the mandibular right second molar (A). It wasn't until the mandibular left second molar had almost fully erupted about a year later, with no sign of the mandibular right second molar, that a red flag was raised.

A progress panorex then displayed what appeared to be an odontoma (B), which was confirmed by biopsy. The x-ray also showed that the mandibular right second molar had fully formed, but had drifted so far distally that it had begun erupting superiorly into the ascending ramus. The crown of the tooth was surrounded by what appeared to be a dentigerous cyst.

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The surgeon determined that the best course of action was to remove the wayward second molar, the surrounding cyst, and the odontoma. All went well, and healing was rapid and uneventful.

My lesson learned: take progress films on all eruption aberrancies observed in the initial records, no matter how insignificant they may seem.

DR. GOODMAN

Dr. Goodman is in the private practice of orthodontics, 30 W. Rahn Road, Dayton, OH 45429. E-mail him at: pmarshallg@live.com.

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Fig. 1 In-house digital lab staff. A. Yesenia Alatorre. B. Chad Dumlao.

Fig. 2 Customized in-house aligner (IHA) packaging.

Fig. 3 Charlyn Austria manages chairside delivery of next aligner stage, using Orchestrate 3D†† and Ortho2 Edge§ software.

Fig. 4 Dental Monitoring ScanBox**** for IHA distance care, including aligners, instructions, aligner case, and chewies.

Fig. 5 Case 1. 30-year-old female patient with mild skeletal Class III relationship and severe lower crowding before treatment.

Fig. 6 Case 1. Patient after 22 months of active aligner treatment.

Fig. 7 Case 2. 19-year-old female patient with mildly divergent skeletal Class III relationship, asymmetrical Class III dental relationship, and anterior open-bite tendency before treatment.

Fig. 8 Case 2. After first stage of leveling and alignment, with posterior intrusion to help close anterior open bite.

Fig. 9 Case 2. Second stage, using bonded aligner attachments and loops for short Class III elastics.

Fig. 10 Case 2. Patient after 10 months of treatment.

DR. PHILIP MATTHEW NISCO DDS

DR. PHILIP MATTHEW NISCO DDS

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