Date: Saturday, December 22, 2007 12:13 AM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 21 Dec 2007 (#2007-88)

There are 3 messages totalling 308 lines in this issue.

Topics of the day:

1.Re: Interesting Pano
2. Special issue
3. Retainers swallowed

Date: Thursday, December 20, 2007 11:23 AM
From: Dr. Robert W. Bruno <Orthos68@AOL.COM>
Subject: Re: Interesting Pano

Hi Karen,

I assume you are referring to ectopic #'s 5 and 6. I have seen this about 6 times over the years. In my past cases, I extracted the primary teeth (as you mentioned) and uprighted #5 in one case to help with canine eruption-of course you have to pay attention to the proximity of the premolar root to the canine.  Not much more you can do, except pray a little. I may have gotten lucky since all of my cases worked out OK. Look forward to hearing other members experiences. Happy Holidays to All!

Rob Bruno
Manhasset, New York

Date: Thursday, December 20, 2007 8:58 AM
From: Adrian Becker <adrianb@CC.HUJI.AC.IL>
Subject: Special issue

Dear All,

I was delighted to see a welcome return to some clinical orthodontics per se in the postings - perhaps that will stimulate a little more interest and correspondence to the ESCO - certainly form the international members. Karen Reisner sent a panoramic film of a 13 year old male and asked " ....Patient has an end-on occlusion.  Besides removing deciduous teeth, any suggestions??". I would make the following observations:-

1. the dental age of the boy is not as late as the presence of 8 deciduous teeth would make it seem.

2. the right maxillary canine and first premolar are transposed, with the canine potentially impacted. The exact location of this canine is impossible to define with any certainty on this film alone, but it would appear that the crown is buccal to the line of the arch and the apex palatal. The apex-to-crown orientation of its long axis has all the signs of being mainly lateral, with a degree of mesial rotation which is greater than is apparent, because of the angle at which it is projected on the panoramic view. The tooth is very high and probably palpable in the height of the sulcus.

3. The left canine is potentially impacted slightly palatal to the line of the arch (judging by the degree of its enlargement relative to that of the central incisor).

4. All 8 deciduous teeth may be defined as over-retained, because each of their permanent successors has more than 2/3 of its normal root length.

5. Most important and often missed, time for the eruption of the mandibular permanent second molars has passed, judging by the amount of their root development and these teeth are potentially impacted between the third molars and the concave CEJ area of the distal of the first molars. In a follow-up radiograph of 1 year from now, I would expect to see that their position will become considerably more mesially tipped and still at the same height.

Suggestions are difficult to make, since we have seen no other records. However, for starters I would be wary about extracting all the deciduous teeth without placing space maintainers. In the mandible, I would otherwise expect the leeway to close rapidly and, perhaps more than normal. This may improve the chances of the second permanent molars, but crowd up the more anteriorly placed teeth - although maybe this is a good ploy! In the maxilla, extracting the deciduous canines and first deciduous molars is important to create an environment helpful to resolving the two canines and I would want hold on to any extra space that might be available to permit me to enhance this environment. A cone beam CT of the anterior maxilla will definitively locate the canines and, particularly on the right side, is an essential tool in helping to define the treatment approach, but I would do this only about 6 months after the maxillary deciduous canines and first molars had been extracted. I would be concerned about the possibility of resorption of the root of the left lateral incisor by the adjacent canine and so I would not delay the CT beyond 6 months and I would enter into treatment then.. Nice case!

Adrian Becker

Date: Wednesday, December 19, 2007 11:27 PM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: Retainers swallowed

I had a patient come in a few years ago that had accidentally swallowed his
retainer.  Lower hawley-type retainer...with a central incisor pontic, no
less.  I kind of laughed until he showed me the baggie in which the ER staff
had returned the appliance to him.  They scoped him in order to grab it and
bring it back up.  "I just woke up and swallowed it."  Freakish, but
whatever.  Didn't really buy it, but couldn't get a different story out of

About a year later, his sister came in and explained that there was a tube
and excessive amounts of beer involved in incident.

So be sure to warn all those teenagers out there to remove their retainer
prior to shoving the tube with beer down their throat!

scott smoron