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DR.MUHAMMAD ASIM
RESIDENT(ORTHODONTICS)SBDC,PESHAWER
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Adult pts missing teeth compromised anchorage Implants are required for future prothesis.
Implants are placed before orthodontic treatment.
Initially for anchorage
After, as abutment for fixed prothesis
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Age;30yr Extracted teeth Anterior crossbite Skeletal ClassIII malocclusion
Consultation with a team of specialists
Treatment plan Leveling and alignment,uprightening & intrusion of mand. 3rd molars
Orthognathic surgery to correct skeletal deformity Fixed prothesis
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Ti- implants were placed bilaterally in mandible,mesial to 3rd molars. Buried in soft tissue for 6 months Implant location
Diagnostic wax set-upto pre-determine the width of pontics and molar
abutments Position; parallel to the long axis of 1st premolar
After 6months Implants were uncovered
Abutments were placed & composite crowns constructed Composite Bracket placement level with the occlusal plane of
premolar.
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NiTi wire inserted into 3rd molar
After 8months Molar was uprighted & intruded
Implants were then prepared and used as abutment for fixed bridgesbetween premolars and implants
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46 yrs pt with missing several posterior teeth in mandible Moderate Crowding + incisors were in edge-to-edge relationship LR7 had ClassIII furcation defect with significant bone loss on mesial side
Objective Retract mandibular incisors Level and align upper arch Correct o/j & o/b Left Sufficient space for pontics
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Strategy Ext molars, replace with implants Retract incisors with implants
Treatment sequence Implant placement plus provisional crowns
Diagnostic wax set-up..to simulate the future position of teeth
Level & alignment of upper incisors Retract lower incisors via elastomeric chains
Sufficient space was left for pontics and abutments Fixed prothesis
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8/2/2019 Managing Complex Orthodontic Problems
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50 yr old woman with several posterior teeth missing Over-eruption of upper molars & premolarsinsuffient space for lower
pontics. Primary objective
To Intrude the over-erupted teeth Strategy
Intrusion via Repelling magnetic force
Implant placement
Plastic stage was placed over mandibular abutments Samarium cobalt was placed in the occlusal surface of plastic stage
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A removable segmental stent containing a magnet was placed over themaxillary teeth
When magnets were brought into contact,repelling force intrude theupper teeth but ont implants.
To achieve maximum magnetic force
Acrylic splint contacting remaining teeth
Intermaxillary elastics during sleep to keep teeth together and magnets incontact
As molar intruded,adjust splint After 8 months 3mm intrusion of molar & premolars
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Factors affecting the success of implant when used for anchorage Treatment planning
interdisciplinary approach
Restorative dentist,periodontist,oral surgeon,orthodontist
Carefuly determine the position of implant
Location of implant
Should be determined carefully
Diagnostic wax set-up
Plastic placement guide
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Timing of implant placement In most cases,before orthdontic treatment Occasionally, during treatment
When tooth movement on either side of implant is unpredicted
Age of patient non-growing pts(M>19yrs:F>14yrs) If placed in growing pts
Teeth will erupt while implant not
Vertical discrepency between teeth and implant
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Insufficient buccolingual width on bone
1st option
Implant placement,allowing thread of implant to be exposed on buccal Freezed dried de-calcified bone placed over threads Polytetraflourethylene membrane is positioned over bone Close flap After 6-8 weeks
Membrane is removed & soft tissue flap is placed directely on implant
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2nd option Increasing width of alveolus before implant placement Expose bone Place freeze-dried decalcified or autogenous bone
Cover with polytetraflouroethylene membrane Implant placement
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Time duration b/w implant placement and orthodontic force application
Usually 4-6 months in mandible Represents the the amount of time required by the body to initially
deposit and then remodel bone around implant
Non-lamellar bone.remodeling.secondery osteon
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Restoration During orthodontic tooth movement, provisional crown should be placed
on implant to allow attachment of bracket Size of crown is determined from diagnostic wax set-up
Final restoration If prothesis is attached only to implant, it can be restored immediately
after orthodontic treatment If prothesis will attach to teeth also , then wait for at least 6months(teeth
are mobile at the end of orthodontic treatment)
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THANKS