3.Methods
Diagnosis: (1) radicular cyst of 74, (2) impacted 34 with root
dilaceration.
Treatment plan: (1) Decompression and drainage of the radicular cyst in
74, (2) Orthodontic traction of 34, (3) In the later stage, the need for
stage II comprehensive orthodontic treatment should be evaluated
according to the requirements and the occlusion of the child.
Local infiltration anesthesia was performed, and the tooth was pulled
out following satisfactory anesthesia. The cyst wall was explored
through the tooth extraction wound, and purulent exudation was observed
after puncturing the cyst wall. A drainage strip was placed after
repeated flushing with normal saline until the flushing solution became
clear. At the same time, to prevent the drainage strip from falling off
and being swallowed or aspirated by the child, the drainage strip was
sutured (Figure 3).
After one week, the drainage strip was removed and washed continuously.
No purulent exudation was observed. At this time, crown of 34 was
visible from the extraction wound of 74 (Figure 4).
After 2 months of follow-up, 74 tooth extraction wounds healed well,
with 34 crown visible, and 34 crown swelled palpably in the buccal
gingiva (Figure 5).
Two months after the operation, the panoramic radiograph showed that the
transmission shadow of the apical area disappeared bone mineral density
increased, and the buccal-lingual impacted image in 34 (Figure 6).
His parents were informed that the radicular cyst in deciduous teeth was
healing well, and a plan was made to perform orthodontic traction of 34.
His parents provided informed consent for the follow-up treatment plan
and signed the consent form.
A mandibular lingual arch was made and bonded to strengthen anchorage,
maintain the mandibular arch, and support the bonding of a local fixed
orthodontic appliance; After the contraindication was eliminated,
fenestration was performed on 34. The crown of 34 was exposed, and local
compression was applied to effectively control the bleeding (Figure 7).
One week after exposure, and following wound healing, the bracket of 34
was bonded and drawn with 0.012 hyperelastic NITI wire (Figure 8).
Two months after exposure, the bracket of 34 was gradually aligned into
the dental arch and was replaced with 0.018 NITI wire to continue to
align the teeth (Figure 9).