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Exposición Exposición
abierta o cerrada o
extramucosa submucosa
Tratamiento de dientes retenidos
Exposición Exposición
abierta o cerrada o
extramucosa submucosa
Tratamiento quirúrgico - ortodóncico
(Gay-Escoda, 1994)
Fenestración
• Anestesia
• Incisión
• Levantamiento de colgajo mucoperióstico
• Osteotomía liberadora
• Preparación de ventana mucosa
• Colocación de medio de tracción
• Tratamiento ortodóncico
280
280 280Kokich
Kokich
Kokich American Journal
American
American of Orthodontics
Journal
Journal andand
of Orthodontics
of Orthodontics Dentofacial
and Orthopedics
Dentofacial
Dentofacial Orthopedics
Orthopedics
280
280
Exposición abierta o extramucosa
280Kokich
Kokich
Kokich American
American Journal
Journal
American ofofOrthodontics
of Orthodontics
Journal andand
Orthodontics Dentofacial September
andDentofacial 2004
September
2004
Orthopedics
Dentofacial 2004
Orthopedics
SeptemberOrthopedics
September
September 20042004
September 2004
Colgajo
FigFigFig
2. A,de
2. 2.A, espesor
Patient
A,
PatientPatient
had total
had
had y mediante
impacted
impacted
impacted osteotomía
maxillary leftleft
maxillary
maxillary canine.
left
canine. seB,
canine.
B, obtiene
Buccal
B,
BuccalBuccalacceso
object
object
object rule aindicated
rule una
rule caratooth
indicated del
indicated diente
tooth was
tooth
was was
Fig
Fig2.2.A,
Fig
incluido. 2.A,Patient
A,Patient
Patient
Posteriormente
positioned had
labially. impacted
had
C,
had impacted
se
Teeth maxillary
talla
impacted were maxillary
una leftleft
ventana
initially
maxillary canine.
left enand,
aligned,
canine. B,mucosa,
canine. Buccal
laand,
B, Buccalobject
B,because
Buccal
se rulerule
object indicated
rule
reposiciona
canine
object crown tooth
indicated waswas
tooth
apicalmente
was
indicated was
positioned
tooth
positioned
positioned labially.
labially. C, C,
Teeth Teeth
were were initially
initially aligned,aligned, and, because
because canine
canine crown crown
was was positioned
positioned
positioned
positioned labially. C, Teeth
labially. C,Teeth were
Teeth initially
were aligned,
initially and,and,
aligned, because
becausecanine crown
canine was
crown positioned
was positioned
labially,
positioned
colgajo y se
labially,
labially, any anyany
of of
3 3
labially.
cementaof 3 C,
uncovering
un
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uncovering techniques
were
aditamento
techniques
techniques could
initially
para
could could
be be
aligned,
la used.
tracción
be
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because
en
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cuspcanine
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tip tip was
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labially, anyany
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cusp positioned
tip was above
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mucogingival
labially,
mucogingival
mucogingival ofjunction
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3junction
andand
uncoveringand
waswas wasdisplaced
techniques could
displaced
displaced D, D,
mesially.
be used.
mesially.
mesially. D,Apically
However, positioned
Apically
Apically cusp tip flap
positioned
positioned wasflap technique
positioned
flap was
above
technique
technique was was
mucogingival
mucogingival junction and
junction was
and displaced
was mesially.
displaced D,
mesially. Apically
D, positioned
Apically positionedflap technique
flap techniquewas was
chosen.E, E,
mucogingival
chosen.
chosen. After
E,
After Aftergingival
junction and
gingival
gingival tissues
tissues was
tissueshad
had hadhealed,
displaced
healed,
healed, tooth
tooth was
mesially.
tooth
was D, gradually
was Apically
gradually
gradually moved
movedmoved distally.
positioned flapF, F,
distally.
distally. Placed
technique
(Kochik,
F,
Placed in
in 2004)
Placedits itsits
was
in
chosen. E, After
chosen. gingival
E, After tissues
gingival hadhad
tissues healed, tooth
healed, waswas
tooth gradually moved
gradually distally.
moved F, Placed
distally. in itsin its
F, Placed
correct
chosen.
correct
correct E,position.
position.After gingival tissues had healed, tooth was gradually moved distally. F, Placed in its
position.
correct position.
correct position.
correct position.
Exposición cerrada o intramucosa
3
(impacted[TI] OR included[TI] OR retained[TI] OR displaced[TI]) AND
#3 (close* OR “closed-eruption”[TI]) AND (open* OR “open-eruption”[TI]
OR “apically positioned flap”) AND periodontal[TIAB] NOT “case
report”
Search canine*[TIAB] OR incisor*[TIAB] OR "anterior teeth" NOT
1
molars AND (impacted[TI] OR included[TI] OR retained[TI] OR
#4 displaced[TI]) AND (close* OR “closed-eruption”[TI]) AND (open* OR
“open-eruption”[TI] OR “apically positioned flap”) NOT “case report”
AND systematic review
Selección de la información
Vermette ME, et al (1995). Uncovering labially impacted teeth:
apically positioned flap and closed-eruption techniques. The
2 Estudios Angle orthodontist 65(1).
• Objetivo:
Examinar diferencias estéticas y periodontales entre dientes anteriores maxilares
como resultado de fenestración con técnica reposición apical de colgajo (técnica
abierta), y con la técnica cerrada.
• Material y métodos:
• Objetivo:
Examinar diferencias estéticas y periodontales entre dientes anteriores maxilares
como resultado de fenestración con técnica reposición apical de colgajo (técnica
abierta), y con la técnica cerrada.
• Material y métodos:
Levemente impactado: 12 mm
Moderadamente impactado: 12-15 mm
Severamente impactado: >15 mm
Estudio clínico 1
• Evaluación de los dientes previamente impactados:
• Margen gingival
• Nivel de inserción
• Longitud de corona
Levemente
impactado
Moderadamente
impactado
Severamente
impactado
Estudio clínico 1
Resultados
Críticas al estudio
• No indica método de obtención de valor de la muestra
• Objetivo:
Comparar estado pulpar y periodontal despues de la
exposición y tratamiento ortodóncico de incisivos centrales
maxilares impactados, mediante técnica abierta y cerrada.
.
• Métodos:
Dos grupos: Grupo técnica abierta: 11 pacientes, entre 15 y
38 años. Seguimiento 10 años. Grupo técnica cerrada: 11
pacientes, entre 14 y 28 años. Seguimiento 9 años.
Evaluación estadística de datos: variables clínicas y
radiográficas comparados con test chi cuadrado.
Estudio clínico 2
• Resultados
Diferencias estadísticamente significativas entre los dos grupos
fueron encontrados para largo de la corona clínica y soporte
óseo, los incisivos centrales expuestos por técnica abierta
mostraron coronas más largas y soporte óseo disminuido en
comparación con la técnica cerrada. A nivel pulpar no se
observan diferencias.
Interpretación general
• Objetivo:
Probar la hipótesis nula de que no hay diferencias en los resultados entre
utilizar un método quirúrgico abierto o cerrado para exponer los caninos
que se han desplazado hacia el techo de la boca.
• Resultados
Ninguno de los estudios cumplió los criterios para ser incluidos en la revisión.