CLINICAL CASE REPORT Figure 18, 19: Exposure of crown of #11 and a bonded 0.014 ligature hook. TAD placed between teeth #13 and 14 and power chain for distal traction. Calcium sulfate was placed to help with soft tissue healing. Figure 20: There was severe root reabsortion of root of #9, and bonded traction hook on #11. This image taken at time of crown exposure for attachment of traction hook. Figures 21, 22, 23: This is a first image after three months active traction of #11. The tissues were healthy tissues had some gingivitis. X-rays after four months show distancing of #11 from #9, passing next to #10. E-Surge scalpel (Parkell) was made, bleeding controlled with topical astringent (Ultradent) achieving a dry surface and proceeded to bond a custom-made hook using 0.014 liga-ture wire. Placed 8mm by 1.6mm TAD on palate between #13 and #14 to achieve skeletal anchorage and started distalization using elastic chain attach-ing hook to TAD head. Covered the exposed tissue and tooth with calcium sulfate powder to create better soft tissue healing and conserve exposure of tooth surface (Figures 18, 19, 20). Progress Visits Recare visits continued, always done by her treating GP dentist, and taking the conventional recare images. Figures 21, 22, 23 were taken between three to four months after active traction was taking place. Soft tissues around TAD and #6 had irritation due to plaque pres-ence but the healing post-surgical was very good. The radiographic images showed the space created between #9 and #11. The reabsorp-tion of apical portion of the root of #9 was between one-third to one-half root, but there was no symp-tomatology reported. While this movement was taking place, the patient was in 0.016 X 0.022 NiTi arch wires holding spaces created and expansion achieved of Figures 24, 25: Distal vector of traction completed after six months of traction. Skeletal and dental anchorage set up to move #11 into a vertical eruptive mode. Power chain used to cause eruptive vector of force while holding #12, #13 stable with TAD anchorage. 16 Fall 2024 JAOS
Journal of the American Orthodontic Society Fall 2024: Page 16
