Tooth movement through mandibular idiopathic osteosclerosis during comprehensive orthodontic treatment

Abstract

In this case report, we demonstrate successful orthodontic tooth movement in a mandibular idiopathic osteosclerosis (IO) patient during treatment for a gummy smile and lip protrusion. A 21-year-old female presented with the chief complaint of a gummy smile and lip protrusion. Clinical examination revealed a straight profile, lip incompetence, and a curled upper lip. An excessive maxillary gingival display was noted during smiling. Intraorally, she exhibited an anterior deepbite and mandibular anterior crowding. Radiographic examinations identified an IO between the mandibular right first and second premolar roots, contacting the lingual aspect of the second premolar root at the apical third level. The treatment consisted of 3 stages: (1) leveling and alignment; (2) maxillary intrusion; and (3) total arch distalization. Treatment duration was 3 years 4 months. No complications related to the IO were observed. Treatment outcome was well-maintained at the 1-year posttreatment. A comprehensive orthodontic treatment involving maxillary intrusion and total arch distalization was successful in the presence of a mandibular IO directly impacting the mandibular premolars. There were no immediate or long-term complications. Using a typical orthodontic setup and force, teeth could be moved into and out of the IO with radiodensities comparable to those of the mandibular lingual cortex. Knowing the IO’s radiodensity, anatomic relationship to adjacent roots, and the status of the periodontal ligament could guide a clinician in planning a safe and effective tooth movement.