Diagnosis and etiology

A young female patient was referred to our dental clinic to resolve a malocclusion disorder due to missing teeth. She was unsatisfied with the functional aspect of her dentition. She had a second upper right molar very damaged by caries (17) (Figs. 1 and 2); it was also extruded due to missing antagonist teeth (I and II lower right molars 46–47) (Fig. 3). The first upper molar was medially oriented due to a II premolar agenesis. There were some metal ceramic crowns in her upper left maxillary arch with a very poor esthetic appearance. A thorough examination, which included mounted diagnostic casts, was performed.

Clinical examination, panoramic radiography, mounted diagnostic casts, and cephalometric analysis revealed a partially edentulous mandible, and the diagnosis was established: anterior deep bite, a I skeletal class and a III dental class, supraeruption, and drifting and rotation of elements 16 and 17 (Figs. 4 and 5).

Because of her youth, esthetic requirements, and economic opportunities, the patient was advised she could be treated with a multidisciplinary approach to achieve a satisfactory esthetic and functional rehabilitation with restored occlusion.

Treatment objectives

The following treatment objectives were established for this patient: (1) conservative and endodontic treatment in the teeth damaged by caries; (2) reestablishment of the correct occlusal plane; (3) corticotomy surgery (performed with a piezo device) to accelerate orthodontic-assisted tooth intrusion, alignment, and tipping; and (4) improvement of mouth posterior function through implant surgery to replace missing teeth (performed with a piezo device).

Treatment progress

After the diagnostic workup was completed, a treatment plan was developed using a specialist team approach involving endodontic, orthodontic, oral surgery, and prosthodontic specialists. The proposed treatments included orthodontic intrusion and tipping of the I and II upper right molars (16 and 17) and uprighting of the lower wisdom teeth and dental alignment.

The first step consisted of endodontic treatment of element 17 and subsequent fiber post buildup and esthetic restoration on elements 11 and 21.

After that, the 26 pontic removal was planned, and subsequently, orthodontic brackets were placed (Figs. 6, 7, and 8).