‘The teeth are not the problem; the jaws are’ Dr Anne-Maree Cole

Finding Their Own Way: Bilateral Ectopic Premolar Teeth that Spontaneously Repositioned during a Course of Jaw Development Orthodontic Therapy:
A Case Report and Literature Review

Anne Maree Cole and Laurence J Walsh

This case report describes a unique situation where bilateral impacted premolar teeth moved spontaneously into the correct 3-dimensional position without orthodontic force, settling into the location predestined for them within the maxilla. The case illustrates the remarkable ability of teeth to “find their way” to a proper 3-dimensional position within the jawbones without any intervention, when freed from the situation of impaction by providing suitable space to give them an eruption pathway. The required space in the maxillary arch was created using a two-fold approach that leveraged bone remodelling processes and the current understanding of bone physiology, with an Anterior Growth Guidance Appliance followed by treatment of the maxillary teeth using the Controlled Arch System protocol. This clinical approach followed the line of argument that “the teeth are not the problem; the jaws are”. The case also illustrates the important principle of treatment being “as much as necessary, but as little as possible”. In this case, surgical exposure and orthodontic traction were able to be avoided, because the genetic template, that evolved physiologically over millions of years, was able to be expressed.

Keywords: Orthodontic Tooth Movement; Bone Modelling; Tooth Eruption