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References

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The management of the migration of maxillary incisors

From Volume 49, Issue 10, November 2022 | Pages 848-851

Authors

Hugh Devlin

BDS, BSc, MSc, PhD

Senior Lecturer in Restorative Dentistry, University Dental Hospital of Manchester.

Articles by Hugh Devlin

David Waring

BChD, MDSc, MFDS RCS (Eng), MOrth RCS (Ed), FDS (Orth) RCS(Ed)

Specialist Registrar in Orthodontics, Liverpool University Dental Hospital, University Dental Hospital of Manchester.

Articles by David Waring

Abstract

Forward migration of the upper incisors can be very distressing for patients and difficult for the dentist to manage and treat. We summarize the aetiology of this condition in older patients and discuss how this can be managed with a combined orthodontic and restorative approach.

CPD/Clinical Relevance: A combination of orthodontics and restorative dental treatment may be useful in managing migration of the upper maxillary teeth.

Article

The upper incisor teeth have several forces acting on them that serve to maintain their position in the adult patient. In a stable dentition, the forces from the lips and tongue are in balance and tooth movement is prevented. Periodontal disease and occlusal forces can combine to initiate tooth movement. When migration of the maxillary teeth is progressing, the lower lip becomes trapped underneath the palatal surfaces and no longer serves to restrain further tooth movement. This accelerates the forward proclination and splaying of the maxillary teeth.

Periodontitis has been described as a primary aetiological factor in tooth drifting,1,2 and this seems logical because good bone support for the teeth is important in its prevention. Inflammation of the periodontium will predispose to tooth movement. More important in the case report described here is that the length of the crowns relative to the periodontal support was increased. This increases the leverage on the teeth so that any force has a greater effect in tilting the teeth.

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