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Dental Tribune Middle East & Africa Edition | July-August 2015 21paediatric tribune < Page 20 > Page 24 *markedtermsareregisteredbrandnamesandtrademarks CopraSintec K perfection in Argon-Sintering-Alloys • Dental caries of the primary molars 55, 65, 74, 75, 85, 84 • Unsealed first permanent mo- lars • 11 in crossbite • Gag reflex Treatment Plan In lieu of the problem list, the following treatment plan was carried out: Phase 1 • Dental prevention (Fissure sealants of the first permanent molars, Fluoride, diet analysis/ advice and oral hygiene advice) • Monitor the eruption of 21 for another 3 months. Phase 2 • If no further eruption occurred and at the advice of the consult- ant orthodontist: arrange for the surgical removal of the super- numerary tooth with or without a gold chain attachment on 21 to allow extrusion of the said tooth. •Asthepatientwasdentallyanx- ious (could not cope with having treatment under local anaes- thesia with or without inhala- tion sedation) and also needed restorative treatment it was de- cided to surgically remove the impacted supernumerary under general anesthesia (GA) and re- store the teeth at the same time (Complete Oral rehabilitation under GA). • LT’s mother consented for the aforementioned treatment to be carried out under GA. This was carried out in a GA day case set- ting. The elective day case GA The following treatment was carried out under the elective GA: a) Restorative treatment - Fissure sealants of the 6s - Pulpotomies with stainless steel crowns on 85, 84, 74, 75 and composites with fissure sealants on 55 & 65 b) Surgical treatment - After giving local anaesthesia, a continuous palatal intracre- vicular (sulcular) incision was carried out from 54 to 64 (Fig. 5) - Raised a mucoperiostial flap with the nasopalatine bundle exposed and preserved (Fig. 6) - The palatal bone was exposed and a bulbosity was noted in the supernumerary ($) area. The overlying “egg shell” bone was removed with an osteotome. The $ was identified carefully as not to be confused with tooth 21 (Fig. 7) - The $ tooth was elevated atrau- matically as possible (Fig 8 a, b & c) - The bone was filed and irrigat- ed with saline and tooth 21 was incisally-exposed. A decision not the place a gold chain attach- ment on 21 was made as 21 was not covered with bone. (Fig. 9) - The flap was repositioned and interrupted sutures were placed (resorbable sutures) after expo- sure of 21 with a small buccal apically repositioned flap (Fig. 10 a & b). - Extraction of loose 52, 62 - A post surgical intra-operative assessment was carried out (Fig 11 a, b & c) Follow up post surgery At one-week follow up, the pa- tient was reviewed. She had no complaints. Tooth 21 had begun to erupt (Fig. 12). At one month’s follow up, tooth 21 had erupted in cross bite. Tooth 11 was al- ready in cross bite. Phase 3 • This phase included intercep- tive orthodontics which involved Fig. 5. Palatal intracrevicular incision Fig. 9. A survey of the surgical site after irrigation and bone filing was made. Figs. 8. (a, b & c) show sequence of careful elevation of the supernumerary ($) tooth. Figs. 11 (a, b & c). Show the immediate post operative views Fig.6.Raisingapalatalmucoperiosteal flap Figs. 10 (a & b). Repositioned palatal flap and wound closure with resorbable sutures. Tooth 21 is now exposed after a small apically repositioned flap Fig. 7. Exposure of the supernumerary tooth $ bulge palatally. the cross bite correction of both teeth 11 & 21. Upper and lower alginate im- pressions were taken (with dif- ficulty due to LT’s gag reflex) to fabricate an upper removable anterior segment palatal expan-