Root Exposure of a Lower Permanent Incisor
Hello, fellow ALFers 😃,
A very concerned mother brought her 6 year-old daughter for a consultation. During the checkup visit at her dentist’s office, she had inquired about the exposed root. The dentist recommended a periodontal procedure a few years down the road to cover the root with a free gingival graft. He also stated that it was too early to do any orthodontic treatment.
Images 1 + 2, March 2017
This type of root exposure occurs commonly when there is insufficient space in the arch. The bud of a permanent incisor may shift either to the lingual or labial and erupt ectopically, with the long axis retroclined.
In the case of labial eruption, we see root exposure due to a lack of attached gingiva. The exposed root surface tends to be sensitive to touch, which, in turn, makes it painful to brush there; plaque build-up and a tight mentalis muscle aggravate the situation.
For this patient, I first used a lip bumper positioned at the height of the exposed root surface. Taking the pressure off helped the gingiva to recover while relaxing the mentalis muscle. As always, myofunctional therapy was a much-needed support.
Images 3 + 4, June 2017
A lip bumper is not always easy to wear for the patient. At times, the mentalis muscle, instead of relaxing, is fighting the lip bumper. In addition, oral hygiene in the area requires an irrigation device like a WaterPik and usually help from a parent.
I was always hesitant to allow my patients to take their lightwire appliances out - the risk of distortion is big. When you look at image 3, you see that the end of the left lingual arm is showing above the occlusal plane. That happened when the mother took the appliance out because a food particle was wedged in between the lip bumper and the teeth.
It can be a good alternative to make the lip bumper detachable. I am planning to cover the details in a future newsletter.
During the following months, we saw gradual improvement.
Image 5, Sept. 2017
Image 6, Dec. 2017
I continued treatment with a different design without a lip bumper. The root exposure kept improving because during arch development the crown of the tooth moved towards the labial with probably minute lingual movement of the root.
Images 7 + 8, August 2018
Image 9, July 2019
Image 10, Nov. 2019
If cases are finished with fixed mechanics and a rectangular arch wire, teeth can be torqued precisely into the desired position. Since this is a strictly mechanical approach, it is not in line with the ALF philosophy where we focus on removing obstacles to the inherent self-healing mechanism of the body.
That being said, AFTER gentle arch development with lightwire appliances and unwinding of cranial strains, a patient will tolerate a mechanical approach with fixed appliances much better.
Warm personal regards and happy ALFing,
P.S. The ALF 101 online seminar is available to osteopathic physicians and myofunctional therapists at a reduced price. Please inquire about the discount coupon.
You probably know about "ALF Therapy and Cranial Osteopathy 101" (available online and live). But there is more:
- ALF 101 Intensive - LIVE (limited to four participants)
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