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Montiel-López PA, García-Nuñez JC, Muro-Jiménez ML, Soto-Chávez AA, Martínez-Rodríguez VM, Rodríguez-Montaño R, Ruiz-Gutiérrez AC. Management of intrabony defects associated with the iatrogenic use of orthodontic elastic bands: A case report. World J Clin Cases 2025; 13:105685. [DOI: 10.12998/wjcc.v13.i20.105685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Revised: 02/22/2025] [Accepted: 03/10/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND The generation of intrabony defects due to the iatrogenic use of elastic bands is an undesirable situation that can result in persistent gingival inflammation with subsequent bone degradation, thus ultimately leading to tooth loss.
CASE SUMMARY This clinical case involved a 27-year-old male patient who complained of persistent inflammation and bleeding in the upper anterior region of the gums, despite having undergone dental cleaning for at least 4 years. The dental and medical history indicated the use of removable orthodontic appliances for 8 years, after which braces were placed for 2 years. The intraoral evaluation revealed inflammation and localized suppuration in teeth 11 and 12. Measurements of 2-7 mm for probing depth and 1-5 mm for clinical attachment loss were detected, and combined bone loss was observed via radiographs. Based on the clinical and radiographic findings, localized stage III, grade C periodontitis was diagnosed. During subgingival debridement, two elastic bands emerged around the involved teeth. The bone defects persisted; therefore, they were surgically addressed using a papilla preservation flap and guided tissue regeneration (GTR).
CONCLUSION The use of elastic bands of various sizes and elasticities is often essential in multiple orthodontic treatments. However, it is crucial to perform a thorough check-up for each patient during treatment and at the end of treatment to remove any remaining residue of resin, metal bands, or orthodontic bands. Additionally, it is imperative to inform the patients of the importance of attending their follow-up appointments. The use of elastic bands in orthodontics requires special care; moreover, GTR is a management option for intrabony defects associated with the iatrogenic use of bands.
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Affiliation(s)
- Patricia A Montiel-López
- Periodontics Program, Department of Integrated Dentistry Clinics, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Juan C García-Nuñez
- Periodontics Program, Department of Integrated Dentistry Clinics, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Mari L Muro-Jiménez
- Periodontics Program, Department of Integrated Dentistry Clinics, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Alma A Soto-Chávez
- Periodontics Program, Department of Integrated Dentistry Clinics, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Vianeth M Martínez-Rodríguez
- Periodontics Program, Department of Integrated Dentistry Clinics, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Ruth Rodríguez-Montaño
- Department of Health and Illness as an Individual and Collective Process, University Center of Tlajomulco, University of Guadalajara, Tlajomulco de Zuñiga 45641, Jalisco, Mexico
| | - Alondra C Ruiz-Gutiérrez
- Periodontics Program, Department of Integrated Dentistry Clinics, University Center of Health Sciences, University of Guadalajara, Guadalajara 44340, Jalisco, Mexico
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Xie C, Liu X, Mei J, Liu Y, Yu H. Periodontal repair for advanced bone loss caused by orthodontic elastic bands: A case report with 7-year follow-up and literature review. Clin Case Rep 2023; 11:e7061. [PMID: 36937646 PMCID: PMC10014515 DOI: 10.1002/ccr3.7061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
A 16-year-old girl developed severe acute periodontitis involving the maxillary central incisor and lateral incisor caused by elastic bands. Periodontal surgical interventions and orthodontic adjustment achieved good outcomes which were maintained for 7 years. This report demonstrates the criticality of correct diagnosis, early periodontal surgery, and interdisciplinary approach.
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Affiliation(s)
- Chengjie Xie
- Department of Periodontics, Stomatological HospitalSouthern Medical UniversityGuangzhouChina
| | - Xiaohao Liu
- Department of Periodontics, Stomatological HospitalSouthern Medical UniversityGuangzhouChina
| | - Jie Mei
- Department of Periodontics, Stomatological HospitalSouthern Medical UniversityGuangzhouChina
| | - Yeungyeung Liu
- Department of Periodontics, Stomatological HospitalSouthern Medical UniversityGuangzhouChina
| | - Huimin Yu
- Department of Periodontics, Stomatological HospitalSouthern Medical UniversityGuangzhouChina
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Actinomycosis as a Rare Local Manifestation of Severe Periodontitis. Case Rep Dent 2020; 2020:5961452. [PMID: 32089900 PMCID: PMC7021467 DOI: 10.1155/2020/5961452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
Actinomycosis is a chronic suppurative infection primarily caused by anaerobic gram-positive filamentous bacteria, primarily of the genus Actinomyces. Oral-cervicofacial actinomycosis is the localization found most often, presenting as a soft tissue swelling, an abscess, a mass lesion, or sometimes an ulcerative lesion. Periodontitis-like lesions, however, are rare findings. This report describes the case of a 41-year-old healthy female patient (nonsmoker), who was referred to the clinic with dull and throbbing pain in the second quadrant. Tooth 25 showed increased mobility and probing pocket depths up to 10 mm, with profuse bleeding upon probing. Radiographically, considerable interproximal horizontal bone loss was found, and the diagnosis of periodontitis stage 3, grade C was made. The situation was initially stabilized with adhesive splinting and local anti-infective therapy. Two weeks later, the bone defect was treated with guided tissue regeneration (GTR) using a xenogenic filler material (BioOss Collagen) and a resorbable membrane (Bio-Gide). Due to a suspicious appearance of the excised granulation tissue, the collected fragments were sent for histopathological evaluation. This evaluation revealed a chronic granulomatous inflammation with the presence of filamentous bacterial colonies, consistent with Actinomyces. The patient was successfully treated. While there are only few reports in the literature, actinomycotic lesions represent a rare but possible finding in cases with localized periodontal destruction. In conclusion, systematic biopsy of the infrabony tissue in localized periodontal lesions may help to provide a more accurate counting of Actinomyces-associated lesions, thereby improving diagnosis, therapy, and prevention.
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Konstantonis D, Brenner R, Karamolegkou M, Vasileiou D. Torturous path of an elastic gap band: Interdisciplinary approach to orthodontic treatment for a young patient who lost both maxillary central incisors after do-it-yourself treatment. Am J Orthod Dentofacial Orthop 2018; 154:835-847. [PMID: 30477782 DOI: 10.1016/j.ajodo.2018.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
Abstract
Spacing between the maxillary anterior teeth is a common concern for young patients and their parents. Patients often consider a diastema to be an annoying but minor problem; they might consult their general dentists for help, or try to address the issue themselves by applying elastic "gap bands." Moreover, parents, without any informed consent, sometimes accept this erroneous method as an easy and inexpensive treatment approach. A 9-year-old boy had severe acute periodontitis involving the maxillary central incisors caused by the placement of an elastic band and its apical migration. Despite periodontal and surgical interventions, the maxillary central incisors were finally extracted, and the patient started orthodontic treatment. The orthodontic treatment plan included maxillary lateral incisor substitution to replace the lost central incisors and mesialization of the maxillary posterior dentition. An interdisciplinary approach with excellent cooperation among the orthodontist, general dentist, and other dental specialists obtained an esthetically pleasing and optimized functional result. Treating the diastema between the anterior teeth with elastic gap bands and without fixed orthodontic appliances should be avoided. Patients should seek proper orthodontic advice for even small-scale orthodontic problems to prevent catastrophic outcomes, as exhibited in this case report.
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Affiliation(s)
- Dimitrios Konstantonis
- Department of Orthodontics, National and Kapodistrian University of Athens, Athens, Greece; Clinic for Orthodontics and Paediatric Dentistry, Center of Dental Medicine, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Ross Brenner
- Center for Advanced Dental Education, Department of Orthodontics, Saint Louis University, Saint Louis, Mo
| | - Marina Karamolegkou
- Department of Orthodontics, National and Kapodistrian University of Athens, Athens, Greece
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Localized Bone Loss Resulted from an Unlikely Cause in an 11-Year-Old Child. Case Rep Dent 2018; 2018:3484513. [PMID: 30073098 PMCID: PMC6057407 DOI: 10.1155/2018/3484513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
Periodontal diseases have several causes, amongst them, by foreign bodies. In this case report, an 11-year-old child who lived in a rural area and has never been treated by a dentist presented an extensive horizontal bone loss and edema on the region of tooth 44. The diagnosis of foreign body was obtained after biopsy, since an elastic band around the middle of the root tooth was found. The elastic band was not radiopaque, and the patient did not inform that she found the elastic band on the floor of the school and introduced the tooth by herself. Based on the case reported, it is concluded that anamnesis and clinical and radiographic examination are fundamental strategies to obtain the diagnosis, but sometimes, especially in children, there may be inconsistencies that can be elucidated by a biopsy.
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Rafiuddin S, YG PK, Biswas S, Prabhu SS, BM C, MP R. Iatrogenic Damage to the Periodontium Caused by Orthodontic Treatment Procedures: An Overview. Open Dent J 2015; 9:228-34. [PMID: 26312093 PMCID: PMC4541303 DOI: 10.2174/1874210601509010228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/04/2015] [Accepted: 03/10/2015] [Indexed: 11/24/2022] Open
Abstract
In orthodontic treatment, teeth are moved in to new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.
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Affiliation(s)
- Syed Rafiuddin
- Department of Orthodontics, Sri Hasanamba Dental College & Hospital, Hassan, Karnataka, India
| | - Pradeep Kumar YG
- Department of Oral Medicine & Radiology, Government Dental College & Hospital & Research Institute, Bellary, Karnataka, India
| | - Shriparna Biswas
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
| | - Sandeep S Prabhu
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
| | - Chandrashekar BM
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
| | - Rakesh MP
- Department of Periodontology, Rajarajeswari Dental College & Hospital, Bangalore-560074, Karnataka, India
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Orthodontic elastic embedded in gingiva for 7 years. Case Rep Dent 2013; 2013:212106. [PMID: 23984109 PMCID: PMC3745853 DOI: 10.1155/2013/212106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/10/2013] [Indexed: 11/17/2022] Open
Abstract
Dental materials especially orthodontic elastics often get embedded in gingival tissues due to iatrogenic factors. If retained for a long time, inflammatory response starts as asymptomatic crestal bone loss and may progress to severe periodontal abscess. Unsupported orthodontic elastics used for diastema closure may result in exfoliation of teeth, while elastic separators may get embedded in interdental gingiva if banding is performed without removing it. These cases of negligence are detrimental for survival of affected teeth. This paper highlights a case of orthodontic elastic embedded in interproximal gingiva of a 23-year-old healthy female for 7 years after completion of fixed orthodontic treatment. Surprisingly, there was no clinical sign of inflammation around elastic band and it was removed easily without any local anaesthesia. However, mild crestal bone loss was observed on periapical radiograph. The gingiva healed completely after sub gingival debridement.
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