Tooth separation potential problems

A displaced orthodontic elastic separator was proposed as being the source of a gingival abscess that progresses to severe bone loss and exfoliation in a healthy adolescent patient with sound periodontal status prior to commencement of orthodontic treatment. After one year of undergoing orthodontic treatment, the patient presented with dull pain and mobility in the left upper permanent molar for which there was no apparent etiology. On clinical examination the patient had gingival inflammation, associated with a deep pocket and severe mobility (Grade III) in relation to the same teeth. Radiographic examination ofan Orthopantomogram (OPG) and IntraOral Periapical Radiograph (IOPAR) revealed a chronic periodontal abscess with severe necrosis of the periodontal ligament and severe alveolar bone loss. On curettage it was found that there was orthodontic elastic separator which was displaced sub gingivally. Active orthodontic forces were temporarily removed and splinting was done. 6 month follow up showed no mobility and significant improvement of alveolar bone height.