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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 2  |  Issue : 3  |  Page : 289-291

Simple treatment of ectopic eruption with a stainless steel crown


Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India

Date of Web Publication12-Jun-2015

Correspondence Address:
Dr. Sidhant Pathak
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Pavillion Road, Davangere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.158719

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  Abstract 

Ectopic eruption is a developmental disturbance in which the tooth fails to follow its normal eruption pathway. The purpose of this clinical report was to introduce a simple and effective way of performing ectopic eruption treatment with a stainless steel crown (SSC). In this report, the ectopic eruption case was successfully treated with SSC in 2 months. This case report demonstrates that a SSC could provide many benefits over other traditional treatment modalities and thus could be used for correcting ectopic eruption at an early age.

Keywords: Ectopic eruption, permanent maxillary first molar, stainless steel crown


How to cite this article:
Poornima P, Pathak S, Bharath K P, Roopa K B. Simple treatment of ectopic eruption with a stainless steel crown. CHRISMED J Health Res 2015;2:289-91

How to cite this URL:
Poornima P, Pathak S, Bharath K P, Roopa K B. Simple treatment of ectopic eruption with a stainless steel crown. CHRISMED J Health Res [serial online] 2015 [cited 2020 Aug 14];2:289-91. Available from: http://www.cjhr.org/text.asp?2015/2/3/289/158719


  Introduction Top


Tooth eruption is a process whereby the forming tooth migrates from its intraosseous location in the jaw to its functional position within the oral cavity. Ectopic eruption is one of the problems that arise during the transitional dentition period. It occurs due to the deviation in the normal path of eruption leading to tooth locked apical to the distal surface of the molar. [1] Ectopic eruption of permanent first molars occurs in 3-4% of children. The maxillary arch is usually affected, and very rarely it is seen in the mandible. [2] Pulver indicated that the etiology of ectopic eruption of the maxillary first molar was a combination of a small maxilla, larger primary and permanent molars, and abnormal angulation of the eruption of the permanent first molars. [3] Young classified ectopic eruption of the permanent first molar into two forms: (1) Reversible; and (2) irreversible (called "jump" and "hold"). In the reversible form, the ectopically erupting permanent first molar frees itself spontaneously from a locked position and erupts into occlusion. This reversible pattern occurs in approximately 66% of ectopically erupting permanent first molars. [4] In the irreversible form, the permanent first molar remains in a locked position until active treatment is provided, or premature exfoliation of a primary second molar occurs. In cases of premature exfoliation of the primary second molar, a significant loss of the dental arch occurs, and the permanent first molar often tips mesially with some rotation. [5] Bjerklin and Kurol noted that the most permanent molars would free themselves and erupt normally by 7 years of age. [6]

This paper presents a case report with unilateral ectopic permanent maxillary first molar treated with a stainless steel crown (SSC).


  Case report Top


A 7-year-old girl came to the Department of Pedodontics and Preventive Dentistry for general check-up. The patient was in good general health. Extra-oral examination revealed no significant findings. Intraoral examination revealed permanent maxillary left first molar locked beneath the adjacent primary second molar [Figure 1]a. There were no tooth mobility and no tenderness to percussion in relation to primary second molar. An intraoral periapical radiograph revealed mesially erupting maxillary left first permanent molar with associated resorption of the primary second molar [Figure 2]a. Correlating clinical and radiographic findings, the left maxillary permanent first molar was diagnosed as ectopic eruption. It was decided to place SSC (3M ESPE, St. Paul, MN, USA) on second deciduous left molar extending below the mesial marginal ridge of the first permanent molar. Conventional tooth preparation of the primary second molar was done carefully keeping in mind not to harm adjacent permanent tooth and SSC was cemented. An intraoral periapical radiograph was taken to confirm the proper extension of SSC [Figure 2]b. The patient remained asymptomatic when she reported 1 week after treatment. After 2 months, permanent first molar got unlocked and erupted in the proper position as depicted both clinically and radiographically [Figure 1]b and [Figure 2]c.
Figure 1: Intraoral photograph of ectopically erupting permanent maxillary left first molar (a) before treatment (b) after treatment

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Figure 2: IOPA showing ectopically erupting permanent maxillary left first molar (a) pre-operative (b) after SSC cementation (c) after 2 months

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  Discussion Top


Most ectopic teeth will eventually erupt into normal position. It is advised to intervene immediately after the tooth penetrates the alveolar crest. Sim recommends early treatment which would prevent space loss of 6-8 mm. [7] Traditionally, various techniques such as elastic separators, brass wire, or Halterman appliance have been used for correction of ectopically erupting permanent first molar. [8] In most cases, however, separator or brass wire alone is not effective since the amount of space that could be created is limited. Kennedy and Turley have described different modalities for clinical management of ectopic permanent molars. They recommended that when primary molar has not suffered excessive resorption and is symptom free, it could be used as abutment tooth for a Halterman type appliance. [9],[10] Although Halterman type appliance is effective, but it is bulky, requires additional lab procedures and necessitates preparation of the occlusal surface of permanent first molar. [10] Kennedy recommended modified Halterman appliance, which is a reverse band and loop appliance with a bonded button on the permanent molar and chain elastic for disimpaction. However, the appliance required changing of chain elastic at 2-3 weeks interval. In addition, taking an accurate impression of the hamular notch and good communication with the lab was mandatory with this modified appliance. [2]

Keeping in mind the disadvantages of conventional treatment modalities, it was decided to place SSC on second deciduous right molar. SSC provided a smooth surface against which mesially erupting permanent right first molar got upright within 2 months. Use of SSC demonstrates a single sitting technique which can be used in children who are uncooperative and cannot come frequently to the clinic for activation of appliances. Furthermore, this technique is simple, cost effective, less time consuming and requires only clinical follow-up with no additional lab procedures.


  Conclusion Top


This case report emphasizes that the early detection and correction of ectopic eruption is very essential. Because of the benefits of SSC over other traditional treatment modalities, preference should be given to use them in children who require correction of ectopic eruption of the permanent first molar.

 
  References Top

1.
Yaseen SM, Naik S, Uloopi KS. Ectopic eruption - A review and case report. Contemp Clin Dent 2011;2:3-7.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Kennedy DB. Clinical tips for the Halterman appliance. Pediatr Dent 2007;29:327-9.  Back to cited text no. 2
    
3.
Pulver F. The etiology and prevalence of ectopic eruption of the maxillary first permanent molar. ASDC J Dent Child 1968;35:138-46.  Back to cited text no. 3
    
4.
Young DH. Ectopic eruption of the permanent first molar. J Dent Child 1957;24:153-62.  Back to cited text no. 4
    
5.
Gehm S, Crespi PV. Management of ectopic eruption of permanent molars. Compend Contin Educ Dent 1997;18:561-6, 8.  Back to cited text no. 5
    
6.
Bjerklin K, Kurol J. Prevalence of ectopic eruption of the maxillary first permanent molar. Swed Dent J 1981;5:29-34.  Back to cited text no. 6
    
7.
Sim JM. Minor orthodontic tooth movement in children. 2 nd ed. St. Louis: CV Mosby Co.; 1977. p. 493.  Back to cited text no. 7
    
8.
Kim YH, Park KT. Simple treatment of ectopic eruption with a triangular wedging spring. Pediatr Dent 2005;27:143-5.  Back to cited text no. 8
    
9.
Kennedy DB, Turley PK. The clinical management of ectopically erupting first permanent molars. Am J Orthod Dentofacial Orthop 1987;92:336-45.  Back to cited text no. 9
    
10.
Halterman CW. A simple technique for the treatment of ectopically erupting permanent first molars. J Am Dent Assoc 1982;105:1031-3.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
Introduction
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Discussion
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