Adjunctive Orthodontic Applications in Dental Implantology
Implant placement is often necessitated for replacement of teeth with pathologically damaged alveolar bone due to periodontitis or traumatic injury. Surgical augmentation of resorbed bone has many limitations, including lower efficacy of vertical augmentation than horizontal augmentation, as well as morbidity associated with grafting procedure. Orthodontic therapy has been proposed as a useful method for augmenting the resorbed alveolar bone and reforming aesthetically appealing gingival margin, prior to implant placement. This narrative review summarizes the available evidence for the application of orthodontic strategies that can be used as adjunct in selected cases to augment bone volume for the future implant site and maintain space for the prosthetic parts of the implant. These are (1) orthodontic extrusion of compromised teeth to generate vertical bone volume and enhance gingival architecture, (2) tooth preservation and postponing orthodontic space opening to maintain bone volume in future implant site, (3) orthodontic implant site switching to eliminate the deficient bone volume or risky implant sites, and (4) the provision of a rigid fixed-bonded retainer to maintain the implant site. Although there are no randomized controlled clinical trials to evaluate the efficacy of orthodontic therapy for implant site development, clinical case reports and experience document the efficacy of orthodontic therapy for this application.
Interdisciplinary management of a clinical case. Preoperative clinical (a,b) and radiographic (c) images at initial presentation. Note the palatal position of the crown of the tooth number 9 at the conclusion of orthodontic therapy (d,e). This helps the bone augmentation in the labial part of the socket that is frequently very thin.72 Periapical radiographs during and after orthodontic therapy (f,g). Cross-sectional reconstruction of cone-beam computerized tomography (CBCT) at the end of active orthodontic therapy (h). Extraction socket (i) and extracted tooth number 9 (j).
Vestibular incision subperiosteal tunnel access technique (k). CBCT following healing of bone augmentation (l). Diagnostic wax-up (m) and surgical guide fabricated based on the wax-up (n,o). Immediate postoperative radiograph (p) and clinical image (q) of the implant placed in central incisor position. Virtually designed CAD/CAM abutment (r,s). A ceramometal restoration (t,u).
Preserving, extruding, and restoring tooth number 8 with crown fracture (a,b) in a 14-year-old boy. Although the prognosis of the tooth was poor, implant therapy was not advised at an early age. Therefore, the crown was restored (c) and after root canal treatment, orthodontic extrusion was performed (d,e). The tooth was restored following orthodontic extrusion (f,g), and it has been maintained for almost 5 years after finishing orthodontic treatment.
The orthodontic implant site switching62 uses tooth movement to generate a new bone. (a) A first premolar is pushed distally into the second premolar position, where bone volume deficiency exists. (b) New bone is generated in the first premolar position and can be used for implant placement, obviating the need for bone grafting.
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