Ian Furst, Oral & Maxillofacial Surgeon, Coronation Dental Specialty Group
The solution we used;
The consensus from the comments is that most would have waited for the tooth to erupt. In this case, the orthodontist had asked that tooth 1.4 be extracted and the 1.3 be further exposed and bonded. Because we are a multi-disciplinary practice, I had the luxury of having the periodontist I work with take a look as well. Both of us were concerned that tooth 1.3 would develop recession on traction. Because there would be a good band of keratinized tissue between 1.3 and the extraction site of 1.4, I felt it would be relatively simple to rotate the flap above the tooth rather than risk recession. Thanks to everyone for the great debate in the comments section. See the video below for details on the flap design and outcome. All the best. Ian.
For all those with a surgical side.
A 16 year old boy with severe crowding has a buccally displaced tooth #1.3. The plan is to extract teeth 1.4, 2.5, 3.5 and 4.5, further expose the crown of tooth #1.3 to place a bracket with chain and orthodontically erupt it into the plane of occlusion.
You notice that #1.3 has an insignificant band of heavily keratinized tissue to the buccal.
The decision is made to complete an apically repositioned flap and expose more of the clinical crown. You’d like to reposition some of the more heavily keratinized tissue over the buccal CEJ .
Download the attached picture to draw, photoshop, paint-by-numbers or otherwise modify it to show your flap design for an apically repositioned flap. In the reply section upload your creation with a comment about why you’ve selected the flap design. Otherwise, send us your best team office picture and defend a choice to simply erupt the tooth.
My flap (with its problems, pitfalls and limitations) will get uploaded after the discussion.