Severe side effects on all the anterior lower teeth of a bonded retainer: a clinical case : Gravi effetti collaterali sui denti anteriori inferiori di un retainer fisso: un caso clinico

OBJECTIVES This case report presents the possible and unexpected clinical severe complications of a bonded mandibular lingual retainer and an achievable therapeutic solution. MATERIALS AND METHODS 18-year-old boy comes to our observation; he reports a previous orthodontic treatment and not to carry out regular check-ups. Intraoral examination shows: class I malocclusion, flexible and intact spiral wire retainer bonded on the lingual surface of the lower front teeth, inferior midline deviated to the left side, lower incisors proclined and inclined to the left side, both mandibular canines and incisors wrongly torqued. Orthopantomography (OPT) shows a moderate root resorption of the lower front teeth with a very important divergence of the roots of left canine and lower incisors. Cone beam computed tomography shows the root of the right canine almost completely out of the bone on its lingual side and the root of the left canine out of the bone on its buccal side. We start a new orthodontic treatment to realign the teeth and to correct the transverse malocclusion. At the end of treatment, the smile of the patient was normalized with a good balance of the occlusal plane. RESULTS AND CONCLUSIONS At the end of treatment, the smile of the patient was normalized with a good balance of the occlusal plane. A good and stable molar and canine class I occlusion was achieved with correct overjet, overbite and transversal relationships. Orthopantomography showed the correction of the inclination of the lower front teeth with a moderate apical root resorption of the four lower incisors that was present also in the initial OPT. CBCT showed the correction of the axial inclination of the right canine with a good lingual bone thickness. On the left canine the good axial inclination achieved was evident; lingual bone thickness was ideal but on the buccal side there was no adequate amount of cortical bone. Although fixed retainers are generally adequate in preventing relapse, sometimes their inadvertent activity causes distortion of the dental arch. If not periodically checked by clinicians, such reported in this case report, fixed retainers may cause devastating complications and orthodontic retreatment could be the solution in restoring the physiological arch shape. CLINICAL SIGNIFICANCE Fixed retainers can cause major complications for the dental elements affected by the retainer in terms of unwanted inclinations and movements with consequent damage to the periodontal structures. Regular monitoring by clinicians is therefore highly recommended. Orthodontic retreatment may prove to be the ideal solution to restore the physiological shape of the arch and the correct inclination of the roots of the affected teeth. OBJECTIVES This case report presents the pos sible and unexpected clinical se vere complications of a bonded mandibular lingual retainer and an achievable therapeutic solution. MATERIALS AND METHODS 18-year-old boy comes to our ob servation; he reports a previous orthodontic treatment and not to carry out regular check-ups. In traoral examination shows: class I malocclusion, flexible and intact spiral wire retainer bonded on the lingual surface of the lower front teeth, inferior midline deviated to the left side, lower incisors pro clined and inclined to the left side, both mandibular canines and in cisors wrongly torqued. Orthop antomography (OPT) shows a moderate root resorption of the lower front teeth with a very important divergence of the roots of left canine and lower incisorsCone beam computed tomogra phy shows the root of the right canine almost completely out of the bone on its lingual side and the root of the left canine out of the bone on its buccal side. We start a new orthodontic treat ment to realign the teeth and to correct the transverse malocclu sion. At the end of treatment, the smile of the patient was normal ized with a good balance of the occlusal plane. RESULTS AND CONCLUSIONS At the end of treatment, the smile of the patient was normal ized with a good balance of the occlusal plane. A good and sta ble molar and canine class I oc clusion was achieved with cor rect overjet, overbite and transversal relationships. Orthopan tomography showed the correc tion of the inclination of the lower front teeth with a moderate apical root resorption of the four lower incisors that was present also in the initial OPT. CBCT showed the correction of the axial inclination of the right canine with a good lin gual bone thickness. On the left canine the good axial inclination achieved was evident; lingual bone thickness was ideal but on the buccal side there was no ade quate amount of cortical bone. Although fixed retainers are gener ally adequate in preventing relapse, sometimes their inadvertent activi ty causes distortion of the dental arch. If not periodically checked by clinicians, such reported in this case report, fixed retainers may cause devastating complications and orthodontic retreatment could be the solution in restoring the physiological arch shape. CLINICAL SIGNIFICANCE Fixed retainers can cause major complications for the dental ele ments affected by the retainer in terms of unwanted inclinations and movements with consequent dam age to the periodontal structures. Regular monitoring by clinicians is therefore highly recommended. Orthodontic retreatment may prove to be the ideal solution to restore the physiological shape of the arch and the correct inclination of the roots of the affected teeth.