Staged Approach Involving Orthodontic Implant Site Development With Labial Root Torque and Guided Bone Regeneration: 3-Year Follow-up Case Report
Restoring periodontally compromised teeth in esthetic zones through dental implant rehabilitation poses significant challenges due to the loss of supporting tissues. This case report describes a staged treatment strategy designed for a 48-year-old woman with advanced chronic periodontitis of the esthetic zone. This approach combined various advanced techniques, including periodontal regeneration, orthodontic implant site development with labial root torque, guided bone regeneration, and soft tissue augmentation. The innovative orthodontic implant site development with labial root torque technique was employed to harness healthy palatal periodontal ligament cells by strategically applying labial root torque in the horizontal labial-palatal direction. This technique uses healthy palatal periodontal ligament cells, which benefits overall periodontal health. The procedure involved gradually shifting hopeless teeth at a rate of 2 mm per month using nickel-titanium wires, thereby maintaining overcorrection for 2 months before extraction. Following successful orthodontic implant site development with labial root torque, the next phase involved guided bone regeneration using a honeycomb-structured titanium membrane. This set the stage for implant placement 6 months later, ensuring a stable foundation for subsequent prosthetic intervention. Soft tissue augmentation was then meticulously performed using an artificial collagen dermis infused with fibroblast growth factor-2, contributing to the overall esthetic outcome. Final prosthesis integration revealed a harmonious blend with the adjacent teeth and gums, underscoring the success of this multidisciplinary approach. This case report provides valuable insights into severe periodontitis in the esthetic field. Our findings highlight the importance of continuously researching and improving procedures for optimal patient care.
Initial views captured in a 43-year-old woman. (a) Facial view of the maxillary anterior teeth. (b) Orthopantomogram. (c) Intraoral radiograph of the maxillary anterior teeth.
Periodontal regeneration therapy. (a) Facial view of the maxillary anterior teeth after initial periodontal treatment. (b) Application of enamel matrix derivative after flap elevation. (c) Placement of allograft material. (d) Resorbable membrane covering. (e) Coronally advanced and sutured flap.
Orthodontic implant site development with labial root torque (OISD-LRT) treatment as a nonsurgical tissue augmentation procedure. (a) Facial view of the maxillary anterior teeth after initial periodontal treatment. (b) Intraoral radiograph of the maxillary anterior teeth after periodontal tissue regeneration. (c) Careful positioning of multibracket devices after placement of temporary crowns. Following the leveling phase of orthodontic treatment, brackets were placed approximately 2 to 3 mm apical to the adjacent teeth. OISD-LRT was performed for the target teeth using the remaining teeth as fixation sources. In OISD-LRT, the bracket’s up light force is harnessed to rotate the tooth root around its center of resistance, causing the root to move toward the labial side. This movement takes advantage of the wider palatal periodontal ligament tissue, leading to a significant enhancement in the horizontal direction.
Guided bone regeneration (GBR) with a titanium honeycomb membrane. (a) Facial view of the maxillary anterior teeth before GBR. (b) Intraoral radiograph of the maxillary anterior teeth after periodontal tissue regeneration. (c) Three-dimensionally bent membrane placed over the ridge. (d) 3D reconstruction of cone beam computerized tomography images 6 months after GBR.
Placement of 2 implants in the anterior region. (a) Sufficient bone volume was confirmed after flap elevation. (b) Implants were placed using guided surgery. (c) The two implants were placed appropriately. (d) Flap was sutured. (e) To compensate for deficient soft tissue, soft tissue augmentation was added.
Follow up 3 years after implant superstructure placement. (a) Facial view of the maxillary anterior teeth. (b) Orthopantomogram. (c) Intraoral radiograph of the maxillary anterior teeth.
Longitudinal cone beam computerized tomography images of changes in tooth #7. (a) Initial view. (b, c) Tooth movement and bone augmentation facilitated by orthodontic implant site development with labial root torque treatment. (d) Horizontal bone augmentation achieved through guided bone regeneration. (e) Implant placed in the ideal position.
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