Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: Achieving esthetic excellence with a multidisciplinary approach

Rehabilitation of Malpositioned Implant in the Anterior Region With Customized Abutment

The misplacement of implants represents an unfavorable complication in dental implant prostheses. Numerous instances necessitating restorative intervention, colloquially termed "rescue cases," encompass either novel occurrences or reconstructions of irreversible implant scenarios. A viable solution for addressing these prosthesis-related challenges is using cementable options. This issue is directly linked to improperly placed implants, which dentists find challenging to rectify due to the absence of angle-correcting abutments from manufacturers. In such situations, the preferred treatments involve either Implant Innovations' universal castable long abutment (UCLA) (Palm Beach Gardens, Florida, United States) or a customized abutment fashioned from the titanium alloy impression coping for the Core-Vent implant (Paragon, Calabasas, California, United States). The Department of Prosthodontics received a referral for a patient with an anterior implant that had been misplaced and required rehabilitation. This case report outlines the chosen treatment approach for an implant situated buccally.

Implant Site Changes in Three Different Clinical Approaches: Orthodontic Extrusion, Regenerative Surgery and Spontaneous Healing after Extraction: A Systematic Review

Both surgical and non-surgical techniques are employed for implant site development. However, the efficacy of these methods has not been thoroughly evaluated and compared. This systematic review aims to compare the biologic, functional and esthetic outcomes of three different approaches before implant placement in both the maxillary and mandibular arches: orthodontic extrusion, regenerative surgery and spontaneous healing after extraction. The systematic research of articles was conducted up to January 2020 in Medline, Scopus and the Cochrane Library databases. Studies were selected in a three-stage process according to the title, the abstract and the inclusion criteria. The methodological quality and the risk of bias of the included studies were evaluated using ROBINS-I tools for non-randomized studies, Rob 2.0 for RCT. Quality evaluation of case reports was performed using CARE guidelines. Through the digital search, 1607 articles were identified, and 25 of them were included in the systematic review. The qualitative evaluation showed a good methodological quality for RCT, sufficient for non-randomized studies and poor for case reports. Based on the available results, both orthodontic extrusion and regenerative surgery allowed the development of the implant site with satisfying esthetic and functional outcomes. Studies about the spontaneous healing of the extraction socket showed resorption of the edentulous ridge, which complicated the implant insertion. No study referred to failures or severe complications. Most of the studies reported only qualitative results. The present systematic review demonstrated that there is a substantial lack of data and evidence to determine which of the presented methods is better for developing a future implant site. Both surgical and non-surgical procedures appear effective in the regeneration of hard tissue, whereas not all the techniques can improve soft tissue volume, too. The orthodontic technique simultaneously enhances both hard and soft tissue.

Orthodontic treatment of periodontal patients: challenges and solutions, from planning to retention

Introduction:

There is an increasing number of adult patients with sequelae of periodontal diseases seeking orthodontic treatment to improve their occlusion and quality of life. However, it is important to highlight that the patient who has vertical bone loss has unique needs, arising from the frequent related pathological migrations. Therefore, it requires an individualized orthodontic treatment in terms of anchorage, biomechanics, and multidisciplinary planning, which raises doubts in the hierarchy of priorities and organization of the treatment plan.

Objectives:

It was proposed a stratified hierarchy of the needs of orthodontic-periodontal treatment in six levels, which were illustrated with examples of clinical cases in which biomechanical planning and a multidisciplinary approach made it possible to obtain a balanced occlusion, aesthetic improvement and stabilization of the results.

Conclusion:

Orthodontic treatment of periodontal patients with a multidisciplinary approach is increasingly frequent and should be planned individually, considering bone losses suffered by each patient. Respecting some limitations, it is possible to improve the level of bone insertion, smile aesthetics and masticatory function, to facilitate oral hygiene through the orthodontic treatment of adult patients with little bone support. It is also important to highlight that there are unique aspects in the orthodontic retention in these cases.

Alveolar ridge alterations in the maxillary anterior region after tooth extraction through orthodontic forced eruption for implant site development: a clinical CBCT study

OBJECTIVE

To investigate the effects of orthodontic forced eruption (OFE) with the straight-wire appliance in the dimensions of the alveolar process when used for extracting compromised maxillary anterior teeth and implant site development.

MATERIAL AND METHODS

Cone-beam computed tomography (CBCT) scans of 7 patients needing extraction of 17 maxillary anterior teeth were obtained before and immediately after OFE. Alveolar plate height and thickness measurements were performed on the buccal and palatal socket walls in CBCT sagittal cross sections. Statistical analysis included sample size calculation, paired t-test, and Wilcoxon test to evaluate alveolar plate dimensional changes and linear regression analysis to assess whether bone changes and the feasibility of implant insertion were associated to tooth type and root length, baseline alveolar plate thickness, and age.

RESULTS

OFE caused statistically significant reduction of the buccal alveolar plate height (1.95 ± 1.83 mm) and significant increase of the palatal alveolar plate height (1.31 ± 2.41 mm) in the central tooth socket areas. Buccal reduction was associated positively to the baseline root length and negatively to the thickness of the corresponding plate in the apical level. A non-significant increase was noted in both buccal (0.23 ± 0.93 mm) and palatal (0.63 ± 1.59 mm) proximal bone. Inadequate buccal bone support hindered immediate implant placement in six sockets; however, all inserted implants showed adequate and gradually increasing stability from insertion to final restoration.

CONCLUSIONS

OFE resulted in favourable increase in the heights of the palatal and proximal alveolar bone and significant reduction in the buccal plate height, which inhibited implant placement in 35% of the treated sockets.

An efficient and noncompliant method for forced eruption with microimplants that is bracket free, and its long-term stability

BACKGROUND AND OVERVIEW

The authors describe a bracket-free forced eruption technique using microimplants that does not require patient compliance and report relapse after long-term observation.

CASE DESCRIPTION

In 2 patients who needed to undergo forced eruption of carious and fractured roots of anterior teeth, the authors erupted the roots forcefully with a cantilever wire and microimplants as an anchorage. The microimplants provided sufficient anchorage by approximately 6 to 7 millimeters for forced eruption of the roots. The authors observed minor relapse of approximately 0.5 mm in both cases at the 1.5-year follow-up.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The forced eruption method using microimplants and a sectional wire is simple and does not require patient compliance, but it does provide precise tooth movement. Clinicians can consider using long retention, overcorrection, and delayed cementation of prosthetic crowns to manage relapse.

In vitro retention efficiency of temporary type zinc oxide cement for orthodontic forced eruption

OBJECTIVE

To assess the retention efficiency of three types of temporary zinc oxide cement trademarks on forced eruption using intracranal wire device.

METHODS

An in vitro evaluation included intracanal wire device displacement and detachment at 50g load force for 120 days and then the retention resistance at maximum load force.

RESULTS

All groups of temporary zinc oxide cements were efficient to support 50g load forces after 120 days. None statistical differences were found between groups. Zinc oxide cements supported a maximum retention load force, which exceeded in more than 84 times the lowest value obtained in controls (420g).

CONCLUSION

Zinc oxide cements are efficient to retain intracanal wire devices on forced eruption processes in vitro and allows removal of both when necessary (wire device and cement, respectively).

Implementation of orthodontic extraction for pre-implant soft tissue management: A systematic review

OBJECTIVE

This systematic review aims to define the recommendations allowing an optimized clinical implementation for orthodontic extraction as a pre-implant soft tissue management procedure.

MATERIALS AND METHODS

A digital search was performed in the Cochrane Library, PubMed, Scopus, and DOSS databases; a pre-screening was conducted according to the title and summary of the articles. After a complete reading, only the articles meeting all of our inclusion criteria were selected, and a second search, this time manual, was performed within their references. The selected articles were then analysed according to twelve parameters.

RESULTS

Thirty-nine articles were included. Despite low statistical evidence in the available literature, some principal guidelines, which seem generally accepted by the scientific community, could be highlighted based on this analysis. However, no ideal clinical protocol could be established.

CONCLUSIONS

Orthodontic extraction is an efficient procedure for pre-implant soft tissue management, however, further studies are needed to establish full clinical recommendations and optimize its clinical implementation.

Evaluation of bone substitutes for treatment of peri-implant bone defects: biomechanical, histological, and immunohistochemical analyses in the rabbit tibia

Purpose

We sought to evaluate the effectiveness of bone substitutes in circumferential peri-implant defects created in the rabbit tibia.

Methods

Thirty rabbits received 45 implants in their left and right tibia. A circumferential bone defect (6.1 mm in diameter/4 mm depth) was created in each rabbit tibia using a trephine bur. A dental implant (4.1 mm × 8.5 mm) was installed after the creation of the defect, providing a 2-mm gap. The bone defect gaps between the implant and the bone were randomly filled according to the following groups: blood clot (CO), particulate Bio-Oss^® (BI), and Bio-Oss^® Collagen (BC). Ten animals were euthanized after periods of 15, 30, and 60 days. Biomechanical analysis by means of the removal torque of the implants, as well as histologic and immunohistochemical analyses for protein expression of osteocalcin (OC), Runx2, OPG, RANKL, and TRAP were evaluated.

Results

For biomechanics, BC showed a better biological response (61.00±15.28 Ncm) than CO (31.60±14.38 Ncm) at 30 days. Immunohistochemical analysis showed significantly different OC expression in CO and BC at 15 days, and also between the CO and BI groups, and between the CO and BC groups at 60 days. After 15 days, Runx2 expression was significantly different in the BI group compared to the CO and BC groups. RANKL expression was significantly different in the BI and CO groups and between the BI and BC groups at 15 days, and also between the BI and CO groups at 60 days. OPG expression was significantly higher at 60 days postoperatively in the BI group than the CO group.

Conclusions

Collectively, our data indicate that, compared to CO and BI, BC offered better bone healing, which was characterized by greater RUNX2, OC, and OPG immunolabeling, and required greater reversal torque for implant removal. Indeed, along with BI, BC presents promising biomechanical and biological properties supporting its possible use in osteoconductive grafts for filling peri-implant gaps.

Facial and occlusal esthetic improvements of an adult skeletal Class III malocclusion using surgical, orthodontic, and implant treatment

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.

Optimum force system for intrusion and extrusion of maxillary central incisor in labial and lingual orthodontics

BACKGROUND

The objective of the present study was to specify an optimum force system for intrusion and extrusion of maxillary central incisor and to compare the effects of bracket positioning at different heights from the incisal edge in Labial Orthodontics (LaO) and Lingual Orthodontics (LiO).

METHODS

A mathematical model of maxillary central incisor with normal inclination was developed. Four cases of heights of bracket slot from incisal edge were considered both in LaO and LiO viz. 3mm, 4mm, 5mm and 6mm. Based on a mathematical model, an optimum force system consisting of an intrusive or extrusive force (F) and a moment (M) was devised and moment (M) to force (F) ratio (M:F ratio) was estimated in each case. Then, three-dimensional Computer Aided Design (CAD) models of incisor and surrounding structures were prepared. To validate an optimum force system, finite element analysis was carried out and force system with derived M:F ratio was applied in each case.

RESULTS

In finite element analysis, results were shown in the form of vector graph of nodal displacements along with undeformed and deformed models. The desired intrusion or extrusion of incisor was observed. Thus, force system devised from a mathematical model was validated with finite element analysis in each case.

CONCLUSION

To achieve intrusion or extrusion, M:F ratios required in LaO were same i.e. 8:1 for aforementioned heights of bracket slot from incisal edge but different in LiO i.e. 0:1, 1:1, 2:1 and 3:1 for the heights of 3mm, 4mm, 5mm and 6mm respectively.

Reconstruction of the Alveolar Buccal Bone Plate in Compromised Fresh Socket after Immediate Implant Placement Followed by Immediate Provisionalization

OBJECTIVE

The aim of this clinical report was to reestablish the buccal bone wall after immediate implant placement. The socket defect was corrected with autogenous bone, and a connective tissue graft was removed from the maxillary tuberosity to increase the thickness, height, and width of the buccal bone and gingival tissue followed by immediate provisionalization of the crown during the same operation.

CLINICAL CONSIDERATIONS

A 66-year-old patient presented with a hopeless maxillary left central incisor with loss of the buccal bone wall. Atraumatic, flapless extraction was performed, and an immediate implant was placed in the extraction socket followed by preparation of an immediate provisional restoration. Subsequently, immediate reconstruction of the buccal bone plate was performed, using the tuberosity as the donor site, to obtain block bone and connective tissue grafts, as well as particulate bone. Finally, immediate provisionalization of the crown followed by simple sutures was performed. Cone-beam computed tomography and periapical radiographs were taken before and after surgery. After 4 months, the final prosthetic crown was made. After a 2-year follow-up, a satisfactory aesthetic result was achieved with lower treatment time and morbidity.

CONCLUSION

This case demonstrates the effective use of immediate reconstruction of the buccal bone wall for the treatment of a hopeless tooth in the maxillary aesthetic area. This procedure efficiently promoted harmonious gingival and bone architecture, recovered lost anatomical structures with sufficient width and thickness, and maintained the stability of the alveolar bone crest in a single procedure.

CLINICAL SIGNIFICANCE

If appropriate clinical conditions exist, immediate dentoalveolar restoration may be the most conservative means of reconstructing the buccal bone wall after immediate implant placement followed by immediate provisionalization with predictable healing and lower treatment time.

Transdisciplinary treatment of Class III malocclusion using conventional implant-supported anchorage: 10-year posttreatment follow-up

INTRODUCTION:

Combined treatment offers advantages for partially edentulous patients. Conventional implants, used as orthodontic anchorage, enable previous orthodontic movement, which provides appropriate space gain for crown insertion.

OBJECTIVE:

This case report describes the treatment of a 61-year and 10-month-old patient with negative overjet which made ideal prosthetic rehabilitation impossible, thereby hindering dental and facial esthetics.

CASE REPORT:

After a diagnostic setup, conventional implants were placed in the upper arch to anchor intrusion and retract anterior teeth. Space gain for lateral incisors was achieved in the lower arch by means of an orthodontic appliance.

CONCLUSIONS:

Integrated planning combining Orthodontics and Implantology provided successful treatment by means of conventional implant-supported anchorage. The resulting occlusal relationship proved stable after 10 years.

Correction of Malpositioned Implants through Periodontal Surgery and Prosthetic Rehabilitation Using Angled Abutment

When dental implants are malpositioned in relation to the adjacent teeth and alveolar bone or in an excessive buccal or lingual position, the final prosthesis rehabilitation impairs the peri-implant health of the gingival tissues and the aesthetics of the patient. Thus, the purpose of this case was to report and discuss a multidisciplinary protocol for the treatment of a compromised maxillary tooth in a patient with an abscess in his right central incisor due to an excessive buccal implant position. The patient presented with an implant-supported provisional restoration on his right maxillary central incisor and a traumatic injury in his left central incisor. The treatment protocol consisted in (i) abutment substitution to compensate the incorrect angulation of the implant, (ii) clinical crown lengthening, (iii) atraumatic extraction of the left central incisor, and (iv) immediate implant placement. Finally, (v) a custom abutment was fabricated to obtain a harmonious gingival contour around the prosthetic crown. In conclusion, when implants are incorrectly positioned in relation to the adjacent teeth, associated with soft-tissue defects, the challenge to create a harmonious mucogingival contours may be achieved with an interdisciplinary approach and with the placement of an appropriate custom abutment.

Aesthetic rehabilitation of a complicated crown-root fracture of the maxillary incisor: combination of orthodontic and implant treatment

The aim of this paper is to present a complex rehabilitation, of fractured tooth, with implants in anterior region considering the orthodontics extrusion to clinical success. At 7 years old, the patient fractured the maxillary left central incisor and the dentist did a crown with the fragment. Twenty years later, the patient was referred to a dental clinic for orthodontic treatment, with the chief complaint related to an accentuated deep bite, and a professional started an orthodontic treatment. After sixteen months of orthodontic treatment, tooth 21 fractured. The treatment plan included an orthodontic extrusion of tooth 21 and implant placement. This case has been followed up and the clinical and radiographic examinations show excellence esthetic results and satisfaction of patient. The forced extrusion can be a viable treatment option in the management of crown root fracture of an anterior tooth to gain bone in a vertical direction. This case emphasizes that to achieve the esthetic result a multidisciplinary approach is necessary.

Optimizing Maxillary Aesthetics of a Severe Compromised Tooth through Orthodontic Movement and Dental Implants

Treatment of severe compromised tooth in the maxillary anterior area still poses great challenge to the clinicians. Several treatment modalities have been proposed to restore the function and aesthetics in teeth with advanced periodontal disease. The present study aims to report a case of traumatic injury of a left-maxillary central incisor with ridge preservation, orthodontic movement, and implant therapy. A 45-year-old woman underwent the proposed treatment for her left central incisor: basic periodontal therapy, xenogenous bone graft, and guided bone regeneration (GBR). Six months after the graft procedure, orthodontic movement by means of alignment and leveling was made and a coronal displacement of the gingival margin and vertical bone apposition could be observed after 13 months of active movement. Afterwards, a dental implant was placed followed by a connective tissue graft and immediate provisionalization of the crown. In conclusion, orthodontic movement was effective to improve the gingival tissue and alveolar bone prior to implant placement favoring the aesthetic results. Six years postoperatively, the results revealed height and width alveolar bone gain indicating that the treatment proposed was able to restore all the functional and aesthetic parameters.