Managing Complex Orthodontic Problems

8/2/2019 Managing Complex Orthodontic Problems

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DR.MUHAMMAD ASIM

RESIDENT(ORTHODONTICS)SBDC,PESHAWER


2/22

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.


6/22

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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8/22

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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12/22

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

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Managing Complex Orthodontic Problems