Page 30 - Dental Practice August 2022

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implantology section

insights to appreciate optimal multi disciplinary care. References
In this case the dictates of future prosthetic rehabilitation
required skilled orthodontic movement to insure proper founda- 1. Winter R. Upgradeable dentistry: Part 1. Dent Today.
tional support, for implants with minimal bone grafting needs post 2009;28:82, 84, 86- 87.
orthodontics. Without using orthodontic movement of teeth; bone
grafting may have been required for the boney cleft present over 2. Kois DE, Kois JC. Comprehensive Risk-Based Diagnostically
tooth #7, loss of bone within tooth #11 site and in areas of antici- Driven Treatment Planning: Developing Sequentially Generated
pated extraction due to bone loss and mobility. Treatment. Dent Clin North Am. 2015 Jul; 59(3): 593-608.
Orthodontic treatment took 18 months and successfully
achieved outlined goals as delineated. (Figures 7, 8, 9 and 10). 3. Feu D1, Menezes FC, Augusto Mendes Miguel J, Cardoso Abdo
Upon removal of brackets there was a noted cosmetic improve- Quintão C. Orthodontic treatment in the severely compromised
ment in smile display, occlusal plane was normalized, buccal corri- periodontal patient. J Orthod. 2012 Dec;39(4):303-13
dor symmetry was improved and canine guidance was established.
4. Cho YD1, Kim S1, Koo KT1, Seol YJ1, Lee YM1, Rhyu IC1, Ku
BIOLOGIC FINISHING Y1. Rescue of a periodontally compromised tooth by nonsurgi-
De-bonding revealed occlusal stability, lack of mobility, lack of cal treatment: a case report. J Periodontal Implant Sci. 2016
fremitus, lack of pain on closure in maximum intercuspation and Apr;46(2):128-34.
no pain in protrusive or excursive border movements. The resolu-
tion of occlusal disharmony and optimization of occlusal vertical Recommended Reading
dental positioning led to resolution of the symptoms for which she 1. Ong MA, Wang HL, Smith FN. Interrelationship between peri-
sought treatment. Simply put: no pain, no mobility, no implants. odontontics and adult orthodontics. J. Clin Periodontol
While this patient understands that perhaps some of the bone 1998;25;271-7.
loss on posterior molars may require further treatment in the future,
the use of a Talon appliance (Space Maintainers, Laboratory Van 2. Kokich VG. Managing complex orthodontic problems: the use
Nuys, CA.) to optimize her occlusion and treat her nocturnal brux- of implants for anchorage. Semin Orthod 1996;2:153-60.
ism along with a conscientious periodontal maintenance program is
all that may be needed to maintain long term stability. The resultant 3. Memcovsky CE, Beny L, Shanberger S, Feldman-Herman S.
photos at 8-year recall demonstrate this stability and periodontal Vardimon A. Bone apposition in surgical bony defects following
health (Figures 11, 12 and 13). orthodontic movement: a comparative histoporphometric study
This case study highlights using orthodontics to optimize between root- and periodontal ligament-damaged and peri-
occlusal schem a prior to extraction and implant placement in a odontally intact rat molars. J Periodontol 2004;75: 1013-9.
patient with severe occlusal traumatism. The fact that biological sta-
bility occurred after placing teeth in a normalized occlusion presents 4. Johal A, Ide M. Orthodontics in adult patient, with special refer-
a treatment planning paradigm that sometimes-biological optimiza- ence to the periodontally compromised patient. Dent Update
tion can lead to decreases or elimination of pathology. Had this 1999; 26: 101-4, 106-8.
treatment plan been attempted without orthodontic correction, the
complexity of care and expense would have been exponential for 5. Panwar M, Jayan B, Arora V, Singh, Orthodontic management
this patient. of dentition in patients with periodontally compromised denti-
tion. J Indian Soc Periodontol. 2014 Mar; 18(2):200-4.
6. Mankoo T, Frost L. Rehabilitation of esthetics in advanced peri-
odontal cases using orthodontics for vertical hard and soft tissue
regeneration prior to implants - a report of 2 challenging cases
treated with an interdisciplinary approach. Eur J Esthet Dent.
2011 Winter;6(4):376-404.

About the AUTHOR

Dr. Richard Winter, a 1988 graduate of the University Of Minnesota School Of Dentistry,
maintains a private practice in Milwaukee. He is a Master in the AGD and a Diplomate in
the American Board of Oral Implantologists/Implant Dentists. He is a Fellow in the
American Academy of Implant Dentistry, and is a Diplomate in the International
Congress of Oral Implantologists. He lectures on Upgradeable Dentistry, Advanced
Treatment Planning,and General Dentistry as a Specialty. He can be reached at
rick@winterdental.com for lecture availability and questions.

30 Dental Practice // July-August 2022 // Vol 18 No 4