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    Conventional Implant With Orthodontic Treatment For Anterior Missing Tooth Management

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    Erwin Sutono
    Implant-bone restoration has become a treatment modality accepted by scientific community for fully and part ially edentulous patients. This breakthrough in oral rehabilitation was initiated by the discovery of titanium based dental imp lants. The original Branemark protocol requires imp lant to be inserted 4-7 months prior to loading.

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    Conventional Implant With Orthodontic Treatment For Anterior Missing Tooth Management

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    Erwin Sutono
    47 views2 pages
    Implant-bone restoration has become a treatment modality accepted by scientific community for fully and part ially edentulous patients. This breakthrough in oral rehabilitation was initiated by the discovery of titanium based dental imp lants. The original Branemark protocol requires imp lant to be inserted 4-7 months prior to loading.

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    Implant-bone restoration has become a treatment modality accepted by scientific community for fully and part ially edentulous patients. This breakthrough in oral rehabilitation was initiated by the discovery of titanium based dental imp lants. The original Branemark protocol requires imp lant to be inserted 4-7 months prior to loading.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views2 pages

    Conventional Implant With Orthodontic Treatment For Anterior Missing Tooth Management

    Uploaded by

    Erwin Sutono
    Implant-bone restoration has become a treatment modality accepted by scientific community for fully and part ially edentulous patients. This breakthrough in oral rehabilitation was initiated by the discovery of titanium based dental imp lants. The original Branemark protocol requires imp lant to be inserted 4-7 months prior to loading.

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    of 2

    ISSN 0975-8437

    INTERNATIONAL JOURNAL OF DENTAL CLINICS 20 11:3(2):85-86

    CASE REPORT

    Conventional implant with orthodontic treatment for anterior missing tooth management
    Girish Nazirkar, Rashmi S aikhedkar, Amit Gupta

    Abstract Improved technology and interdisciplinary team wo rk allo ws dental providers to achieve treat ment goals of function, esthetics, stability and health. Th is paper reports the management of a missing single anterior tooth by conventional implant prosthesis along with adjunctive ortho dontic treatment. Key Words: Implant; Orthodontics;Anterior Teeth. Received on: 05/04/2011 Accepted on: 09/05/2011 Introduction Implant-bone restoration has become a treatment modality accepted by scientific community for fully and part ially edentulous patients.(1) The breakthrough in oral rehabilitation was init iated by the discovery of titanium based dental imp lants capable of achieving anchorage in jaw bone with d irect bone to imp lant contact. This functional ankylosis is often referred to as osseointegration. It was first described by Branemark, Schroeder, and well documented by Davies.(2, 3) The original Branemark protocol requires imp lant to be inserted 4-7 months prior to loading. This long treat ment period may be of great inconvenience, and is sometimes the reason for not choosing imp lant supported restorations.(1) This time-related limitat ion of implant restoration can be made advantageous should the partially edentulous patient require prior orthodontic correction for satisfactory prosthetic rehabilitation. This paper reports the management of a missing upper left central incisor of a young male patient which was replaced by conventional imp lant prosthesis with adjunctive orthodontic treatment. Case Report A 28-year-old male reported to the Dept. of Prosthodontics, CDSH, Rau, Indore, with missing upper left central incisor. Dental history revealed fracture and subsequent extraction of the said tooth 6 months back. Patient was partially edentulous since then. His med ical history was normal. Intraoral examination showed that his oral cavity was in good condition apart from mesial drift ing of upper right central incisor and left lateral incisor also lower anterior teeth were poorly aligned interfering with normal over jet relat ion with planned prosthetic replacement. Other hard and soft tissues were sound. (Figure 1a,1b) As agreed by the patient, the treatment selected was conventional imp lant prosthesis with simultaneous orthodontic correction during healing phase for creating optimum esthetics and incisal guidance. Implant surgery: Under aseptic precautions, left in fraorbital and nasopalatine nerve

    blocks were ad ministered. Two release incisions with crev icular incisions were placed and the surgical site was exposed. In itially drilling was done with round drill and subsequent graded drilling was done with 2mm, 2.8 mm, and 3.2 mm drills.

    Figure 1a and 1b. Pre-operative view

    A self-tapping Hi-tech implant o f size 3.75 x 13 mm was placed at the prepared site using a surgical stent as a guide ( Figure 2a). Implant was screwed into the bone and tightened with a wrench. Sutures were placed to close the surgical site. The patient was recalled after 48 hours for postoperative checkup. No co mplaints were reported by the patient and healing was uneventful. After 7 days, checkup was done and sutures were removed. After one month, implant site was opened and healing screw was removed and replaced by healing cap, which was kept for 15 days.

    Figure 2a. Implant placed, 2b.temporary prosthesis

    Provisional prosthesis: Non-loaded provisional prosthesis was planned which act as a guide for orthodontic correction during healing period. Impression along with imp ression post was made with elastomeric impression material. Lab analog was transferred to the master cast; straight abutment was adjusted and tried in patients mouth. Provisional restoration of heat cure acrylic resin was cemented with temporary cement over adjusted implant abutment in patients mouth (Figure 2b) . Healing Phase / Orthodontic Correction: Sectional orthodontic treatment was planned for both upper and lower anterior teeth. Space

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    regaining for the lost upper left central incisor and align ment of lo wer anterio r teeth was achieved. Ribbon arch brackets were bonded on upper right central and left lateral incisor along with rigid 0.016 Australian stainless steel wire section. An open coil spring was used to regain space lost for missing tooth. In the lower arch pro ximal stripping was done to gain space for align ment of anterior teeth. Ribbon arch brackets were bonded with a flexib le 0.016 NiTi wire section (Figure 3a ). Orthodontic treatment lasted for a period of three months after which final prosthesis was planned.

    4-7 months depending upon bone density at init ial surgery.(7) The partially edentulous case discussed in this article required orthodontic correction of tilted teeth adjacent to implant site and realign ment of lower anterior teeth for creation of ideal pontic space and sufficient overjet respectively. This orthodontic correction could have been a prerequisite for most of the available prosthodontic treatment p lans. In the said edentulous case, orthodontic correction was achieved by sectional orthodontic treatment utilizing the time made available during the healing phase of imp lant, thereby justifying the longer duration conventional implant prosthesis as the treatment of choice.
    Authors Affiliations: 1. Dr. Girish Nazirkar, M .D.S, Prof. and Head, Dept. of Prosthodontics, 2. Dr. Rashmi Saikhedkar M .D.S, Professor, Dept. of Oral and M axillofacial Surgery, 3. Dr. Amit Gupta M .D.S, Lecturer, Dept. of Orthodontics, College of Dental Science, Rau, Indore, M adhyapradesh, India. References: 1. Creugers N, Kreulen C, Snoek P, De Kanter R. A systematic review of single-tooth restorations supported by implants. Journal of Dentistry. 2000;28(4):209-17. 2. Buser D, M ericskestern R, Pierre Bernard JP, Behneke A, Behneke N, Hirt HP, et al. Long term evaluation of non submerged ITI implants. Part 1: 8 year life table analysis of a prospective multi center study with 2359 implants. Clinical Oral Implants Research. 1997;8 (3):161-72. 3. Davies J. M echanisms of endosseous integration. The International journal of prosthodontics. 1998;11(5):391-401. 4. Albrektsson T, Zarb G, Worthington P, Eriksson A. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral M axillofac Implants. 1986;1(1):11-25. 5. M ishra P, Chandrasekaran S, M ohamed JB. Implants in periodontally compromised sites. International Journal of Dental Clinics. 2011;3(1):100-1. 6. Kumar P, Puranik SN. Anterior Spring Cantilever Fixed Partial Denture: A Simple Solution to a Complex Prosthodontic Dilemma. International Journal of Dental Clinics. 2010;2(3):41-3. 7. Branemark P. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand. J Plast Reconstr Surg. 1977;16:1-132. Address for Correspondence Dr. Girish Nazirkar, M DS, Professor and Head of the Department, Dept. of Prosthodontics, College of Dental Science & Hospital, Rau, Indore (M .P.), India. Ph:+0091.9826062698 Email: [email protected]

    Figure 3a. Orthodontic Treatment,3b.Postorthodontic Treatment

    Final Prosthesis: Space regaining and align ment of lower anteriors by orthodontic treatment created desired space for final prosthesis with scope for creating sufficient over jet (Figure 3b). Final p rosthesis of appropriate shade in the form of Porcelain Fused to Metal crown was fabricated, tried and cemented (Figure 4a ,4b). At the one-year recall the imp lant and the crown were in good condition. The patient was very p leased with the result.

    Figure 4a. Final Prosthesis, 4b. Implant radiograph

    Discussion A common axio m in trad itional prosthodontics for partial edentulis m is to provide a fixed partial denture wherever possible.(4) As a result of continued research in treat ment planning, implant design, materials and technique, imp lant prosthesis often offer a mo re pred ictable treat ment course than traditional restorations. One of the commonest procedures performed in conventional implant dentistry is single tooth replacement. The maxillary anterior single tooth implant often can come closer to ideal goals of imp lant dentistry than any other modality.(5, 6) Duration of conventional imp lant prosthodontic treatment may be of g reat inconvenience and limitation because as per surgical and prosthetic protocol suggested by Branemark and progressive bone loading concept by Carl Misch, time required for rigid ly fixated implant to heal and to be restored is approximately

    Source of Support: Nil, Conflict of Interest: None Declared

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