Page 28 - Dental Practice August 2022

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implantology section

FIG 10: Smile display at end of orthodontic treatment FIG 11a: Full face toward end of FIG 11b: Full face after removal
orthodontics orthodontic appliances

FIG 12: Retracted view close up 8 years post operatively FIG 13: Smile view 8 years post orthodontics with no implant placed to date.

with the most thoughtful planning, implant placement to replace root prior to extraction? Can we use terminal teeth to help us
her mobile teeth would require proper mesial-distal and occlusal achieve our goals? The answer of course is yes; if informed consent
vertical space, as well as canine guidance. Obtaining proper occlusal is discussed and documented and the patient understands that teeth
vertical dimension and canine guidance excursive movements will be lost either during or post orthodontic care to achieve ideal-
would serve to protect both the implants and stability of her remain- ized results, use of compromised dentition as anchorage units to
ing dentition. achieve goals is warranted.
If teeth #7-10 and 22-26 required extraction with implant “The use of orthodontics to facilitate a stable cosmetically orient-
replacement, is there enough space for all her teeth to be placed in ed, implant protected occlusion with idealized space creation and
the available arch form? How much osteoplasty would be required bone leveling is not only responsible but justifiable.”
in areas of #22-26 to level the bone and thus level her curve of Spee Orthodontics was prescribed by the General Practitioner with
and Wilson? specific instruction to:
The complicated nature of anticipating final occlusal construct • align and correct rotated teeth
necessitated orthodontic intervention to “set the stage” for proper • distalize upper left quadrant of teeth
implant placement. • level occlusal plane
• intrude #22, 23 and 24
HOW COULD ORTHODONTICS BE TREATMENT PLANNED WHERE? • harmonize both arches
There was AAP IV Localized Severe Periodontal Disease? Is that irre- • level CEJ’s
sponsible? Would participating dentists get sued for tooth loss • bring #7 into the arch in harmony with #10
caused by orthodontic intervention? • achieve canine protected occlusion by using #12 to mimic #11
To answer this question the following scenario can be evaluated: by placing it strategically into #11 site and tipping it to look and act
If a tooth is broken and extraction is inevitable, is it OK to use likes a canine.
orthodontics to erupt this tooth to bring the bone down with the It is imperative that all treating doctors communicate and offer

28 Dental Practice // July-August 2022 // Vol 18 No 4 Continued on page 30 >>