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ISSN 0975 -8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 20 11:3 (2):85-86

INTERNATIONAL JO URNAL OF DENTA L CLINICS VOLUME 3ISSUE 2APRIL-JUNE 2011 85

Conventional implant with orthodontic treatment for anterior missing tooth

managementGirish Nazirkar, Rashmi S aikhedkar, Amit Gupta

Abstract

Improved technology and interdisciplinary team work allows dental providers to achieve treatment

goals of function, esthetics, stab ility and health. This paper reports the manage ment of a miss ing single anterior

tooth by conventional implant prosthesis along with adjunctive orthodontic treatment.

Key Words: Implant; Orthodontics;Anterior Teeth.

Received on: 05/04/2011 Accepted on: 09/05/2011

Introduction

Implant-bone restoration has become a

treatment modality accepted by scientific

community for fully and partially edentulous

patients.(1) The breakthrough in oral rehabilitation

was initiated by the discovery of titanium based

dental implants capable of achieving anchorage in

jaw bone with d irect bone to implant contact. This

functional ankylosis is often referred to as

osseointegration. It was first described by

Branemark, Schroeder, and well documented by

Davies.(2, 3) The original Branemark protocol

requires implant to be inserted 4-7 months prior to

loading. This long treatment period may be of

great inconvenience, and is sometimes the reason

for not choosing implant supported restorations.(1)

This time-related limitation of implant restoration

can be made advantageous should the partially

edentulous patient require prior orthodontic

correction for satisfactory prosthetic rehabilitation.

This paper reports the management of a missing

upper left central incisor of a young male patientwhich was replaced by conventional implant

pros thesis with adjunctive orthodontic treatment.

Case Report

A 28-year-old male reported to the Dept.

of Prosthodontics, CDSH, Rau, Indore, with

miss ing upper left central inc isor. Dental history

revealed fracture and subsequent extraction of thesaid tooth 6 months back. Patient was partially

edentulous since then. His medical history was

normal. Intraoral examination showed that his oral

cavity was in good condition apart from mesial

drifting of upper right central incisor and left

lateral incisor a lso lower anterior teeth were poorlyaligned interfering with normal over jet relation

with planned prosthetic replacement. Other hard

and soft tissues were sound. (Figure 1a,1b) As

agreed by the patient, the treatment selected was

conventional implant prosthesis with simultaneous

orthodontic correction during healing phase for

creating optimum esthetics and incisal guidance.

Implant surgery: Under aseptic

precautions, left infraorbital and nasopalatine nerve

blocks were ad ministered. Two release incisions

with crevicular incisions were placed and the

surgical site was exposed. Initially drilling was

done with round drill and subsequent graded

drilling was done with 2mm, 2.8 mm, and 3.2 mm

drills.

Figure 1a and 1b. Pre-operat ive view

A self-tapping Hi-tech implant of size

3.75 x 13 mm was placed at the prepared site using

a surgical stent as a guide (Figure 2a). Implant was

screwed into the bone and tightened with a wrench.

Sutures were placed to close the surgical site. The

patient was recalled afte r 48 hours for pos t-

operative checkup. No complaints were reported

by the patient and healing was uneventful. After 7days, checkup was done and sutures were removed.

After one month, implant site was opened and

healing screw was removed and replaced by

healing cap, which was kept for 15 days.

Figure 2a. Implant placed, 2b.temporary prosthesis

Provisional prosthesis: Non-loaded

provisional pros thesis was planned which act as a

guide for orthodontic correction during healing

period. Impress ion along with impression post was

made with elastomeric impress ion mater ial. Lab

analog was transferred to the master cast; straight

abutment was adjusted and tried in patients mouth.

Provisional restoration of heat cure acrylic resin

was cemented with temporary cement over

adjusted implant abutment in patients mouth

(Figure 2b) .

Healing Phase / Orthodontic Correction:

Sectional orthodontic treatment was planned for

both upper and lower anterior teeth. Space

CASE REPORT

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ISSN 0975 -8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 20 11:3 (2):85-86

INTERNATIONAL JO URNAL OF DENTA L CLINICS VOLUME 3ISSUE 2APRIL-JUNE 2011 86

regaining for the lost upper left central incisor and

alignment of lower anterior teeth was achieved.

Ribbon arch brackets were bonded on upper rightcentral and left lateral incisor along with rigid

0.016 Aus tralian stainless steel wire section. An

open coil spring was used to regain space lost for

miss ing tooth. In the lower arch proximal stripping

was done to gain space for alignment of anterior

teeth. Ribbon arch brackets were bonded with aflexible 0.016 NiTi wire section (Figure 3a).

Orthodontic treatment lasted for a period of three

months after which final prosthesis was planned.

Figure 3a. Orthodontic Treatment,3b.Postorthodontic Treatment

Final Prosthesis: Space regaining and

alignment of lower anteriors by orthodontic

treatment created desired space for final prosthesis

with scope for creating sufficient over jet (Figure

3b). Final prosthesis of appropriate shade in the

form of Porcelain Fused to Metal crown was

fabricated, tried and cemented (Figure 4a ,4b). At

the one-year recall the implant and the crown were

in good condition. The patient was very p leased

with the result.

Figure 4a. Final P rosthesis, 4b. Implant radiograph

DiscussionA common axiom in traditional

pros thodontics for partial edentulism is to provide a

fixed partial denture wherever possible.(4) As a

result of continued research in treatment planning,

implant design, materials and technique, implant

pros thesis often offer a more predictable treat ment

course than traditional restorations. One of the

commonest procedures performed in conventional

implant dentistry is single tooth replacement. The

maxillary anterior single tooth implant often can

come closer to ideal goals of implant dentistry than

any other modality.(5, 6)

Duration of conventional implantpros thodontic treatment may be of g reat

inconvenience and limitation because as per

surgical and prosthetic protocol suggested by

Branemark and progressive bone loading concept

by Carl Misch , time required for rigidly fixated

implant to heal and to be restored is approximately

4-7 months depending upon bone density at initial

surgery.(7)

The partially edentulous case discussed inthis article required orthodontic correction of tilted

teeth adjacent to implant site and realignment of

lower anterior teeth for creation of ideal pontic

space and sufficient overjet respectively. This

orthodontic correction could have been a

prerequisite for most of the available pros thodontictreatment p lans. In the said edentulous case,

orthodontic correction was achieved by sectional

orthodontic treatment utilizing the time made

available during the healing phase of implant,

thereby justifying the longer duration conventional

implant prosthesis as the treatment of choice.Authors Affiliations: 1. Dr. Girish Nazirkar, M.D.S,

Prof. and Head, Dept. of Prosthodontics, 2. Dr. Rashmi

Saikhedkar M .D.S, Professor, Dept. of Oral andMaxillofacial Surgery, 3. Dr. Amit Gupta M.D.S,

Lecturer, Dept . of Orthodontics, College of Dental

Science, Rau, Indore, M adhyapradesh, India.References:

1.Creugers N, Kreulen C, Snoek P, De Kanter R. Asystematic review of single-tooth restorations

supported by implants. Journal of Dentistry.

2000;28(4):209-17.

2.Buser D, Mericskestern R, Pierre Bernard JP,Behneke A, Behneke N, Hirt HP, et al. Long term

evaluation of non submerged ITI implants. Part 1: 8year life table analysis of a prospective multi center

study with 2359 implants. Clinical Oral Implants

Research. 1997;8 (3):161-72.

3.Davies J. M echanisms of endosseous integration. TheInternational journal of prosthodontics.1998;11(5):391-401.

4.Albrektsson T, Zarb G, Worthington P, Eriksson A.The long-term efficacy of currently used dentalimplants: a review and proposed criteria of success.

Int J Oral Maxillofac Implants. 1986;1(1):11-25.5.Mishra P, Chandrasekaran S, Mohamed JB. Implants

in periodontally compromised sites. International

Journal of Dental Clinics. 2011;3(1):100-1.

6.Kumar P, Puranik SN. Anterior Spring CantileverFixed Partial Denture: A Simple Solution to aComplex Prosthodontic Dilemma. International

Journal of Dental Clinics. 2010;2(3):41-3.

7.Branemark P. Osseointegrated implants in thetreatment of the edentulous jaw. Experience from a

10-year period. Scand. J Plast Reconstr Surg.1977;16:1-132.

Address for CorrespondenceDr. Girish Nazirkar, MDS,

Professor and Head of the Department,

Dept. of Prosthodontics,College of Dental Science & Hospital,

Rau, Indore (M .P.), India.

Ph:+0091.9826062698

Email:gsnazirkar11@yahoo.co.in

Source of Support: Nil, Conflict of Interest: None Declared

mailto:gsnazirkar11@yahoo.co.inmailto:gsnazirkar11@yahoo.co.in