A piezo surgery with corticotomies and implant placement
A piezo surgery with corticotomies and implant placement as part of a multidisciplinary approach to treat malocclusion disorder in an adult patient: clinical report
Abstract
This clinical report illustrates a multidisciplinary approach for the rehabilitation of a young adult patient affected by a bilateral edentulous space and an anterior deep bite. The patient required orthodontics and surgical corticotomy and implantology (both performed with a piezo device). A multidisciplinary planning approach, including orthodontics, oral and periodontic surgery, and restorative dentistry, has an important role in the final outcome of treatment. In fact a dental class I occlusion has been established only on the right side. The left side could not be restored to an ideal class I relationship due to the pontic prosthesis. The original collapsed right posterior occlusion was corrected. A stable posterior occlusion was established, and the balancing interference was eliminated. Centric relation and centric occlusion were established at the same vertical dimension of occlusion. The cephalometric analysis and clinical aspect at the end of treatment showed that the patient had improvements in overbite and overjet.
Multidisciplinary management, including endodontic and restorative dentistry, periodontics, corticotomy-assisted orthodontics, implants, and prosthetics, was used for a young female patient with multiple missing teeth, anterior deep bite, and a malocclusion with cant of the occlusal plane. The interaction of interdisciplinary specialties and careful treatment planning were required. The patient also benefited esthetically from our effort.
Background
In the adult patient, the loss of teeth or periodontal support can cause pathologic migration of a single tooth or group of teeth. This can result in the development of median diastema or general spacing of the teeth with or without incisor inclination, rotation, or tipping of the premolars and molars and consequently collapse of the posterior occlusion with decreasing vertical dimension.
Regaining the lost interocclusal space is a requirement for successful treatment in these cases. A multidisciplinary approach such as reduction of the overerupted teeth, which may require a combination of endodontic treatment, periodontal surgery, and a fixed prosthesis afterwards; extraction of the overerupted teeth; surgical reconstruction of the edentulous space; and orthodontic intrusion of the extruded teeth has been suggested for regaining the original space.
Intrusion of the extrusive opposing teeth orthodontically is the most conservative but also the most difficult and long-acting treatment option.
The maxillary corticotomy is another available and suggested technique that facilitates orthodontic intrusion.
This clinical report illustrates a multidisciplinary approach for the rehabilitation of a young adult patient affected by a bilateral edentulous space. The patient required orthodontics and surgical corticotomy and implantology (both performed with a piezo device).
Serial posts:
- A piezo surgery with corticotomies and implant placement
- A piezo surgery with corticotomies and implant placement (1)
- A piezo surgery with corticotomies and implant placement (2)
- Discussion : A piezo surgery with corticotomies and implant placement (1)
- Discussion : A piezo surgery with corticotomies and implant placement (2)
- Figure 1. Initial frontal intraoral aspect
- Figure 2. Initial lateral intraoral aspect
- Figure 3. Some metal ceramic crowns in the upper left maxillary arch with a very poor esthetic appearance
- Figure 4. The panoramic radiography and cephalometric analysis revealed a partially edentulous mandible
- Figure 5. The panoramic radiography and cephalometric analysis revealed a partially edentulous mandible
- Figure 6. Orthodontic bracket placement: frontal view
- Figure 7. Ortodontic bracket placement: right side view
- Figure 8. Orthodontic bracket placement: left side view
- Figure 9. A microsurgical corticotomy was mandatory to assist orthodontic tipping and intrusion of elements 16 and 17
- Figure 10. A triangular-shaped corticotomy was performed
- Figure 11. A mesiobuccal root surface exposure of element
- Figure 12. The total width flap was sutured
- Figure 13. Implant site preparation: OP5, IM2, OT4, and IM3 (correctly in sequence)
- Figure 14. Implants placement after site preparation
- Figure 15. All implants received immediate healing screws
- Figure 16. After orthodontic treatment was completed, the prosthodontic phase took place
- Figure 17. Implants were used for implant-retained prostheses (abutment-cemented crowns), and a three-unit fixed partial denture pontic (crowns 25–27) was placed
- Figure 18. OPT after prosthodontic finalization
- Figure 19. A full-mouth frontal aspect
- Figure 20. The left side could not be restored to an ideal class I relationship
- Figure 21. A dental class I occlusion was established only on the right side