Modality and risk management for orthodontic extrusion procedures in interdisciplinary treatment for generating proper bone and tissue contours for the planned implant: a case report
© Maeda and Sasaki. 2015
- Received: 8 September 2015
- Accepted: 29 September 2015
- Published: 23 October 2015
In adult interdisciplinary treatments with using dental implants, limited orthodontic treatment, especially orthodontic extrusion (OE), offers many benefits by both correcting teeth alignment and by contributing to the regeneration of periodontal tissues. However, orthodontic procedures carry some risks and unpredictabilities that might compromise tooth and/or periodontal tissue health. Especially in complex cases, it is difficult to decide which orthodontic treatment modalities should be combined, in what sequences they should be applied, and what their force systems and treatment times are.
To achieve optimum results, some cases require two or more OEs to the same site being carried out at different times while taking the treatment effects into consideration. Such staged OE offers minimum intervention and maximum efficiency. In this case report, OE was first applied for orthodontic extraction. After bone regeneration followed by an implant placement and another surgical operation, a second OE was applied to align the inclination of an adjacent tooth. As a result, a predictable prognosis of implants as well as greatly improved esthetics and periodontal tissue health were achieved.
- Interdisciplinary treatment
- Orthodontic extrusion (OE)
- Combination of orthodontic modalities
- Risk management
- Orthodontic extraction
- Periodontal tissue health
- Minimum intervention
Adjunctive orthodontic treatment for adults is tooth movement that is carried out to facilitate other dental procedures necessary to control disease, restore function, and/or enhance appearance . Orthodontic extrusion is an adjunctive orthodontic treatment with the potential to improve bone anatomy in consideration of implant placement .
Because OE is regarded as being simpler and easier than comprehensive orthodontic treatment, this treatment can be mistakenly considered simple and completed without careful planning, which can lead to an unsatisfactory clinical outcome. Orthodontic treatments involve some risks for tooth and/or periodontal tissue that may lead to unpredictable and unsatisfactory results regardless of the complexity of treatments [7–9].
To achieve optimum results, it is important to decide which orthodontic treatment modalities should be combined. In addition, the sequence in which they are applied, the force system, and their treatment time must be considered .
In this case report, two LOTs were applied to the same site at different times, along with tooth extraction and guided bone regeneration followed by implant placement. For this patient, limited orthodontic treatment provided twice during the sequence of overall treatment resulting in improved esthetics and soft tissue health.
A 28-year-old male visited our clinic with a chief complaint of poor esthetics in the maxillary anterior region. The patient was in good general health, and his medical and dental history indicated no contraindications to dental treatment.
Initial preparation with scaling and root planing
Orthodontic extrusion and extraction of the right maxillary central incisor
Implant placement with a bone grafting procedure
A second implant operation for an abutment connection
Orthodontic treatment for the right lateral incisor
Final restoration and retention
An esthetic implant-supported crown with symmetric soft tissue contours was achieved with the combined orthodontic extrusion, orthodontic alignment, and grafting procedures. The maintenance phase has been uneventful.
Orthodontic treatment plays a major role in adult interdisciplinary dentistry. In this case, orthodontic treatments were applied in two stages. In the first stage, OE of the right maxillary central incisor was carried out. In the second stage, the flaring adjacent lateral incisor on the same side was corrected. The first orthodontic treatment made optimal implant placement possible because of regenerated hard and soft tissue after the extraction. In addition, the first stage facilitated esthetic restoration with regenerated alveolar bone and soft tissue [11–13].
The second orthodontic treatment was employed to correct the position and angulation of the lateral incisor using an osseointegrated implant as the orthodontic anchor.
It was important that these orthodontic treatments were not applied simultaneously or with the same force system (orthodontic term: combination of all the forces and moments acting on these teeth).
There were two reasons for selecting a staged approach instead of a simultaneous one. First, if these tooth movements were attempted simultaneously, not only would the extrusion of the central incisor not be effectively achieved, but also the mesio-palatal movement of the right lateral incisor could not be sufficiently controlled. Since a lateral incisor will move to an unhealthy bone-defected area close to a central incisor, there could be the risk of an attachment loss of the lateral incisor [14–16]. In contrast, a staged approach would not incur the risk of attachment loss of the lateral incisor because regenerative therapy was applied first [17–19].
Orthodontic treatments in adults carry higher risks, such as gingival recession, alveolar bone resorption, and root resorption, compared with those in children [22, 23]. When a continuous arch wire is placed on many teeth to provide anchorage, balancing forces can result in unintended outcomes. In this case, the movement of the lateral incisor was achieved in a short period of time by using only one adjacent tooth as anchor because the anchorage for the implant was already in place. Adverse effects of orthodontic force could be minimized because the orthodontic treatment was performed in the shortest period of time possible and in a limited treatment area. The staged approach of orthodontic treatment in this study was carried out with minimum intervention and maximum efficiency.
To prepare optimum implant placement site with improved esthetics and healthy periimplant tissue, orthodontic extrusion is one of the most effective and minimum invasive modalities, however, some cases require staged process with different type of orthodontic approach at different times.
Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. Fourth edition. In: Proffit WR, editors. St. Louis: Mosby; 2007. p. 377–394,644–647.Google Scholar
- Daskalogiannakis J. Glossary of orthodontic terms. Chicago: Quintessence; 2000. p. 158.Google Scholar
- Maeda S, Maeda Y, Ono Y, Nakamura K, Matsui T. Interdisciplinary approach and orthodontic options for treatment of advanced periodontal disease and malocclusion: a case report. Quintessence Int. 2007;38:653–62.PubMedGoogle Scholar
- Maeda S, Ono Y, Nakamura K, Kuwahara T. Molar uprighting with extrusion for implant site bone regeneration and improvement of the periodontal environment. Int J Period Res Dent. 2008;28:374–81.Google Scholar
- Mantzikos T & Shamus I. Case report: Forced eruption and implant site development. Angle Orthod 1998; 68: 179-186.Google Scholar
- Cardaropoli D, Re S, Corrente G, Abundo R. Reconstruction of the maxillary midline papilla following a combined orthodontic-periodontic treatment in adult periodontal patients. J Clin Periodontol. 2004;31:79–84.View ArticlePubMedGoogle Scholar
- Hollender L, Rönnerman A, Thilander B. Root resorption, marginal bone support and clinical crown length in orthodontically treated patients. Eur J Orthod. 1980;2:197–205.View ArticlePubMedGoogle Scholar
- Zachrisson BU, Alnaes L. Periodontal condition in orthodontically treated and untreated individuals. I. Loss of attachment, gingival pocket depth and clinical crown height. Angle Orthod. 1973;43:402–11.PubMedGoogle Scholar
- Zachrisson BU. Cause and prevention of injuries to teeth and supporting structures during orthodontic treatment. Am J Orthod. 1976;69:285–300.View ArticlePubMedGoogle Scholar
- Salzmann JA. Problems of the adult as an orthodontic patient. Am J Orthod. 1970;57:84–5.View ArticlePubMedGoogle Scholar
- López SG, Gaya MVO, Capilla MV. Esthetic restoration with orthodontic traction and single-tooth implant: case report. Int J Periodont Rest Dent. 2005;25:239–45.Google Scholar
- Mantzikos T, Shamus I. Forced eruption and implant site development: soft tissue response. Am J Orthod Dentfac Orthop. 1997;112:596–606.View ArticleGoogle Scholar
- Mantzikos T, Shamus I. Case report: forced eruption and implant site development. Angle Orthod. 1998;68:179–86.PubMedGoogle Scholar
- Ericsson I, Thilander B, Lindhe J, Okamoto H. The effect of orthodontic tilting movements on the periodontal tissues of infected and non-infected dentitions in dogs. J Clin Periodontol. 1977;4:278–93.View ArticlePubMedGoogle Scholar
- Lindskog-Stokland B, Wennström JL, Nyman S, Thilander B. Orthodontic tooth movement into edentulous areas with reduced bone height. An experimental study in the dog. European J Orthod. 1993;15:89–96.View ArticleGoogle Scholar
- Polson AM, Caton J, Polson A, Nyman S, Novak J, Reed B. Periodontal response after tooth movement into intrabony defects. J Periodontol. 1984;55:197–202.View ArticlePubMedGoogle Scholar
- Araújo MG, Carmagnola D, Berglundh T, Thilander B, Lindhe J. Orthodontic movement in bone defects augmented with Bio-Oss. An experimental study in dogs. J Clin Periodontol. 2001;28:73–80.View ArticlePubMedGoogle Scholar
- Diedrich P, Fritz U, Kinzinger G, Angelakis J. Movement of periodontally affected teeth after guided tissue regeneration (GTR)-an experimental piOE study in animals. J Orofac Orthop. 2003;64:214–27.PubMedGoogle Scholar
- Re S, Corrente G, Abundo R, Cardaropoli D. Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report. Int J Periodont Rest Dent. 2002;22:138–45.Google Scholar
- Daskalogiannakis J. Glossary of orthodontic terms. Chicago: Quintessence; 2000. p. 118–9.Google Scholar
- Daskalogiannakis J. Glossary of orthodontic terms. Chicago: Quintessence; 2000. p. 157.Google Scholar
- Harris EF, Baker WC. Loss of root length and crestal bone height before and during treatment in adolescent and adult orthodontic patients. Am J Orthod Dentofac Orthop. 1990;98:463–9.View ArticleGoogle Scholar
- Lupi JE, Handelman CS, Sadowsky C. Prevalence and severity of apical root resorption and alveolar bone loss in orthodontically treated adults. Am J Orthod Dentofac Orthop. 1996;109:28–37.View ArticleGoogle Scholar