Received: 15 Nov. 2014 Accepted: 6 Apr.
2015
Correction of severe tooth rotation by using two different orthodontic
appliances: Report of two cases
Fatemeh Jahanimoghadam DDS, MSc1, Shahla Momenidanayee DMD, MS2,
Marziyeh Karimiafshar DDS, MS3
Case Report
Abstract
BACKGROUND AND AIM: Severe rotation of tooth is one of the most common problems in orthodontics and considered
as a developmental phenomenon. These rotations can cause cosmetic problems, gingival recession, and traumatic
occlusion. By using removable appliances, severe rotations can be treated. Furthermore, gingival damage, tooth
attrition, and transposition of other teeth could be prevented. Early treatment of these rotated teeth could improve dental
aesthetic affecting on child’s behavior and enhanced self-confidence. This case report presents two treated cases using
the removable appliance in severe tooth rotations.
CASE REPORT: Case 1: The severe rotation of right upper central incisor in a 9-year-old girl is corrected with removable
orthodontic appliance and whip spring. Case 2: The severe rotation of left lower lateral incisor in an 8-year-old girl is
corrected with a force couple and elastic anchored on the removable orthodontic appliance.
CONCLUSION: In this paper, it was revealed that to correction the problem, in the first case a removable appliance with a
whip spring was used and in the second case, a removable appliance in combination with bracket and elastic was
efficient to prevent from a complicated orthodontic treatment in the future.
KEYWORDS: Rotation; Removable Orthodontic Appliance; Correction
Citation: Jahanimoghadam F, Momenidanayee S, Karimiafshar M. Correction of severe tooth rotation by
using two different orthodontic appliances: Report of two cases. J Oral Health Oral Epidemiol 2016;
5(1): 46-51.
C
rowding is the most common dental and path of tooth eruption can create tooth
malocclusion and associated with a rotations.1,3 If there are multiple rotations of
reduction in the size of the jaws. The teeth, comprehensive orthodontic treatment
role of crowding in the development with fixed appliances are used. But in cases
of dental caries and periodontal disease has with a single severe tooth rotation, it can be
been confirmed.1 A rotated central incisor used removable appliances, for correction of
creates numerous aesthetic and psychological rotated teeth.4,5
problems for a patient. Tooth rotation is When a fixed orthodontic appliance is used
considered as observable mesiolingual or to correct only some of the teeth in the mixed
distolingual intra-alveolar displacement of dentition, arch wire spans are longer, the wire
the tooth around its longitudinal axis.2 The is springier and large movements are easily
exact etiology of tooth rotation is unknown, possible. However, it may be difficult to use
but it seems to be a developmental fixed appliances correctly during the mixed
phenomenon. Displacement of dental follicle dentition period since the available permanent
1- Assistant Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health
Research Center AND Department of Pediatric Dentistry, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
2- Professor, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
3- Assistant Professor, Endodontology Research Center AND Department of Orthodontics, School of Dentistry, Kerman University of
Medical Sciences, Kerman, Iran
Correspondence to: Fatemeh Jahanimoghadam, DDS, MSc
Email: [email protected]
46 J Oral Health Oral Epidemiol / Winter 2016; Vol. 5, No. 1
http://johoe.kmu.ac.ir, 5 January
Correction of severe tooth rotation Jahanimoghadam et al.
teeth are grouped into anterior (incisor) and practice with the chief complain of severe
posterior (molar) segments. In addition, rotation of the upper anterior tooth
anchorage control becomes difficult as only the (Figure 1). Her medical history revealed no
first permanent molars serve as an anchorage problems. Clinical examination showed a
in the posterior segment of the arch. slightly convex facial profile and symmetric
The whip appliance was introduced by face. The soft tissue of the lips, chin, and nose
Houston and Isaacson in 1980. The original were evaluated. Intraoral examination
appliance has been mildly modified to better revealed class I malocclusion, but over jet and
satisfy the therapeutic needs. This appliance overbite was reduced. In panoramic
consists of a removable orthodontic plate, a radiography, severe rotation of the upper
cantilever spring and a bracket or bonded right central incisor was observed. The device
tube that enables effective correction of included a removable orthodontic appliance,
severely rotated anterior teeth in a short a whip spring and a bonded tube (Figure 2).
period of time. Better anchorage control,
relatively simple force system, easier oral
hygiene management, and less critical patient
cooperation are the advantages of the
appliance.6 Correction of the rotated teeth in
early ages also prevents from irreparable
injuries to the supporting tissues, and dental
follicle transposition.7 Canine-lateral
transposition can be problematic in laterally
mandibular movements.8 In addition,
avoiding of tooth eruption in a rotated
position can reduce the relapse of treatment.9
The early treatment of these rotated teeth
Figure 1. Central incisor with 90° rotation
could improve dental aesthetic affecting on
child’s behavior and enhanced self-
confidence. Researchers have also found that
an attractive appearance and social
acceptance can assist the individual in
achieving social success.10 In this report, two
different methods for correction of severe
tooth rotation by means of removable
orthodontic appliances offered.
In the first case, severe rotation of right
maxillary central incisor in a 9-year-old girl
corrected by whip spring and removable
orthodontic appliance and in the latter one,
severe rotation of lower left lateral incisor in
an 8-year-old girl corrected by a force couple Figure 2. Removable appliance, whip spring and
and elastic anchored on the removable bonded tube
orthodontic appliance.
The removable appliance consists of
Case Report acrylic base plate, circumferential clasps on
Case 1 the maxillary first permanent molars and a
The 9-year-old girl was referred to the private labial arch on the upper primary canines.
J Oral Health Oral Epidemiol/ Winter 2016; Vol. 5, No. 1 47
http://johoe.kmu.ac.ir, 5 January
Correction of severe tooth rotation Jahanimoghadam et al.
Molar Adams clasps and labial arch were problems. In the clinical examination, normal
made of 28 mil (0.7 mm) stainless steel wire growth pattern was seen. In the extra oral
(Dentarum, Germany). A bonded tube examination, the patient’s profile was slightly
(Dentarum, Germany) was bonded on the convex and in front view was normal. Intraoral
1/3 incisal area of the labial surface of central examination showed class II malocclusion with
incisor with light-cured composite resin the severe rotation of the lower left lateral
(Trans Bond XT, 3M Unitek, USA). To incisor and over jet was increased (Figures 4
increase flexibility, the range of motion and and 5). Upper mid-line was deviated to right
easier insertion of coil springs, whip spring (1 mm) and lower midline was deviated to left
was made with a segment of 0.4 mm stainless (2 mm). Space analysis by using radiography
steel orthodontic wire (Dentarum GmbH & revealed lack of space for the eruption of
Co. KG TurnstraBe 31, 75228 Inspringen- permanent teeth in the mandible and maxilla
Germany) and a length of 20 mm. The mesial (7 and 4 mm, respectively).
end of the spring was inserted into the tube
slot and bent toward the gingiva, and the
hook located in the distal end of the wire was
engaged to the labial arch. The patient was
monitored monthly and during 4 months the
upper right central incisor was repositioned to
its normal position (Figure 3). The induction
force of flexibility of the wire corrected the
rotated tooth. After over correcting the tooth
rotation, the appliance was removed, and
retention begins using a modified Hawley
retainer. Circumferential supra crestal
fiberotomy surgery was not performed
Figure 4. Intra oral view of the patient
because no satisfaction of her parents.
Figure 3. Correction of the rotated tooth
Figure 5. Lateral incisor with 90° rotation
Case 2
The 8-year-old girl was referred to the School of In the panoramic radiograph, lateral
Dentistry of Shiraz University of Medical incisor had a severe rotation, and the risk of
Sciences, Iran, with chief complain of severe impaction or incomplete transposition of
rotation of the lower left lateral incisor. The canine-lateral in the same side due to
medical history of the child revealed no superimposition of the canine crown on the
48 J Oral Health Oral Epidemiol / Winter 2016; Vol. 5, No. 1
http://johoe.kmu.ac.ir, 5 January
Correction of severe tooth rotation Jahanimoghadam et al.
lateral incisor root was observed. The device Discussion
included a removable orthodontic appliance, Severe tooth rotation can cause dental and
two brackets (Dentarum, Germany) on gingival problems. It is also can create the
lingual and labial surfaces of the rotated inappropriate appearance and adverse
tooth and elastic 3/16 Median pull (American psychological effects on the child’s life.
Orthodontics EC Certification Service GmbH Although the etiology is clearly unknown,
Sandgasse7, A-9300 St. Veit/glan, Austria). dental follicle displacement and path of tooth
The removable appliance consists of an eruption can be the possible causes.1 In two
acrylic base plate, circumferential clasps on present cases, it seems to be the same causes.
the mandibular first permanent molar, first If these rotations cannot be modified, they
and second primary molars and a labial arch cause a traumatic occlusion that it can cause
on the lower incisors. Labial arch included a gingival recession, root resorption in
double loop at equal distances from the involved teeth. Since fixed orthodontic
brackets (Figure 6). Molar Adams clasps and treatment in childhood and adolescence is
labial arch were made of 28 mil (0.7 mm) not recommended, early correction of severe
stainless steel wire (Dentarum, Germany). tooth rotations using removable devices or a
Two brackets were bonded on the lingual combination of fixed and removable devices
and labial surfaces of the left lower lateral to reduce the injuries mentioned above could
incisor with light cure composite resin (Trans be very useful. Whip spring is an auxiliary
Bond XT, 3M Unitek, USA). Using two equal spring and is usually placed in the molar
forces (a force couple) and elastic 3/16 by the band.4
medium pull from opposite sides of the Jalali and Bagherian11 used whip spring
tooth, lateral incisor was derotated well joined to Adams clasp for correction of sever
during 2 months (Figure 7). rotation of maxillary central incisor. They
didn’t observe any harmful side-effects on
root development. They also mentioned,
mobility and sensitivity to pain until 1 month
after the active phase of treatment was
normal. Mavragani et al.12 mentioned that
since root shortening due to apical resorption
is one of the most serious side-effects of
orthodontic treatment, it seems advisable to
initiate orthodontic correction of the incisors
at a young age during mixed dentition.
Figure 6. Appliance design Complications involving delayed treatment
of a rotated permanent incisor include:
Dilacerations of the developing roots, root
resorption, loss of tooth vitality and
compromised oral hygiene.2 Whip appliance
has many advantages for use in the mixed
dentition as follows:
1. Offering a solution in the mixed
dentition period, relatively in a short time
2. Providing increased vertical and
horizontal anchorage due to palatal coverage
Figure 7. Removable appliance, two brackets 3. Anchorage control is less critical
and elastic in oral cavity 4. Force system is relatively simple when
J Oral Health Oral Epidemiol/ Winter 2016; Vol. 5, No. 1 49
http://johoe.kmu.ac.ir, 5 January
Correction of severe tooth rotation Jahanimoghadam et al.
this appliance is used crown and root movement may be occurred.4
5. Management of oral hygiene is easier Furthermore, this appliance can hurt the
6. Patient compliance is less critical, mucosa if not adjusted carefully.
because when removing the appliance, the It is mentioned that rotations are easy to
damage of mucosa by wire leads to patient treat but very difficult to retain. There is a
discomfort high risk of relapse due to stretching of the
7. Whip appliance can be used in supra-alveolar and transseptal gingival
emergency situations in the mixed dentition, fibers, which slowly reposition. Therefore, it
such as traumatic occlusion of central should be overcorrected and long-term
incisors.13 retention period is needed to achieve the
In the first case, the spring was placed on stability of treatment. Correction of single
the labial arch and the patient didn’t have tooth severe rotation using orthodontic
any limitation in wearing the removable appliances or a combination of fixed and
appliance. After derotation of the tooth, the removable orthodontic appliances is
other appliance was used for retention. affordable and secure way, and the possible
Mobility and mild pain were the natural need for future orthodontic complex
complications of rotation correction, and treatment reduce. Timely correction of these
these complications were observed in both rotations reduces the risk of damage to
patients. In treatment planning of the latter gingiva and teeth and also traumatic
case, using the removable appliance and occlusion decrease. The early treatment of
whip spring wasn’t possible. Therefore, we these rotated teeth could improve dental
used the combination of removable and fixed aesthetic affecting on child’s behavior and
appliances to derotate the tooth. Rotation enhanced self-confidence.
correction by using a light force in early
stages of root development can lead to a Conflict of Interests
stable outcome. Authors have no conflict of interest.
One of the problems with the use of whip
appliance is that much attention should be Acknowledgments
considered not to activate it in the vertical The authors wish to thank the patients for
plane, otherwise unwanted mesiodistal their assistance in all periods of study.
References
1. Proffit W, Fields HW, Sarver DM. Contemporary orthodontics. 4th ed. Oxford, UK: Elsevier Health Sciences; 2006.
2. Das D, Misra J. Early Surgical intervention can eliminate future heavy orthodontic mechanotherapy. Indian J Dent Adv
2013; 5(2): 1222-5.
3. Russell KA, Folwarczna MA. Mesiodens--diagnosis and management of a common supernumerary tooth. J Can Dent
Assoc 2003; 69(6): 362-6.
4. Isaacson KG, Muir JD, Reed RT. Removable orthodontic appliances. Madison, WI: Wright; 2003. p. 30-4.
5. Jahanbin A, Baghaii B, Parisay I. Correction of a severely rotated maxillary central incisor with the Whip device. Saudi
Dent J 2010; 22(1): 41-4.
6. Jahanbin A, Tanbakuchi B. Orthodontic management of a severely rotated maxillary central incisor in the mixed
dentition: a case report. J Dent Mater Tech 2014; 3(2): 82-6.
7. Turkkahraman H, Sayin MO, Yilmaz HH. Maxillary canine transposition to incisor site: a rare condition. Angle Orthod
2005; 75(2): 284-7.
8. Sato K, Yokozeki M, Takagi T, Moriyama K. An orthodontic case of transposition of the upper right canine and first
premolar. Angle Orthod 2002; 72(3): 275-8.
9. Graber LW, Vanarsdal RL, Vig KWL. Orthodontics: current principles and techniques. 5th ed. St. Louis, Mosby; 2011.
p. 975-93.
10. Onyeaso CO, Sanu OO. Perception of personal dental appearance in Nigerian adolescents. Am J Orthod Dentofacial
50 J Oral Health Oral Epidemiol / Winter 2016; Vol. 5, No. 1
http://johoe.kmu.ac.ir, 5 January
Correction of severe tooth rotation Jahanimoghadam et al.
Orthop 2005; 127(6): 700-6.
11. Jalali T, Bagherian A. Combination of removable appliance with whip spring in the treatment of severely rotated
maxillary central incisor in the mixed dentition: A case report. J Mashad Dent Sch 2006; 30(1-2): 161-6. [In Persian].
12. Mavragani M, Boe OE, Wisth PJ, Selvig KA. Changes in root length during orthodontic treatment: advantages for
immature teeth. Eur J Orthod 2002; 24(1): 91-7.
13. Parisay I, Boskabady M, Abdollahi M, Sufiani M. Treatment of severe rotations of maxillary central incisors with
whip appliance: Report of three cases. Dent Res J (Isfahan) 2014; 11(1): 133-9.
J Oral Health Oral Epidemiol/ Winter 2016; Vol. 5, No. 1 51
http://johoe.kmu.ac.ir, 5 January
