Esthetic rehabilitation of mutilated maxillary anterior alveolar segment by combining orthodontic osseous distraction and implant-supported crowns A clinical report.pptx

PAVANKUMAR

1. GOOD MORNING!!!

2. Esthetic rehabilitation of mutilated maxillary anterior alveolar segment by combining orthodontic osseous distraction and implant-supported crowns: A clinical report Udatta Kher , Smita Nimbalkar , Pravinkumar G. Patil and Neha Mehta J Prosthet Dent 2023 Oct 18 . Presented by k S S G PAVANKUMAR MDS IIND YEAR DEPARTMENT OF PROSTHODONTICS

3. CONTENTS INTRODUCTION CLINICAL REPORT DISCUSSION CONCLUSION REVIEW OF LITERATURE CRITICAL EVALUATION REFERENCES

4. The esthetic and functional rehabilitation of missing anterior tooth is one of the greatest challenges that the dentist faces.

5. Treatment options ??? Grafting Moving teeth with pre-prosthetic osseous distraction techniques can be an alternative nonsurgical option to traditional regenerative or reparative surgical therapies to increase bone volume

6. INTRODUCTION Creating a pleasing esthetic appearance in the maxillary anterior region is always challenging, and bony defects in the esthetic zone increase the complexity of surgical and prosthetic procedures. A primary aim when placing implants in patients with bony defects is to increase the bone mass with bone augmentation procedures with or without simultaneous implant placement .

7. Important ae sthetic parameters in the esthetic zone include the soft tissue contour, colour, texture, interdental papilla, interproximal bone height, and gingival phenotype. Bony architecture can be enhanced with preprosthetic osseous distraction techniques as an alternative nonsurgical option to traditional regenerative or reparative surgery A retrospective case-series with 12 patients who underwent a modified orthodontic extrusion technique reported a significant increase in the average bone volume of 31.58 mm 2 and in the average linear bone of 4.63 mm

8. A clinical report described distraction osteogenesis with a ankylosed tooth to enhance the bone volume for implant placement. In another report, a severely resorbed atrophic mandibular partial edentulous ridge was regenerated by using vertical distraction osteogenesis and subsequent implant placement. Distraction osteogenesis helps grow bone without the need for multiple surgical interventions . However, evaluating the implant sites for hard and soft tissue structures is critical to predicting long-term esthetic outcomes.

9. Alveolar distraction osteogenesis is a clinically efficient method for correcting alveolar deformities by enhancing the healthy bony architecture , i f the bone is distracted along its long axis, osteogenesis can be induced . Orthodontic tooth movement is a practical treatment option to increase bone volume for implant placement. Orthodontic extrusion follows a similar principle to grow the hard and soft tissues before implant placement, but the literature is scarce.

10. For the present patient, esthetic rehabilitation was carried out in the maxillary anterior region after the removal of 2 ankylosed central incisors by mesial movement of the lateral incisors and by placing the implants in the healthy bone in the lateral incisor positions.

11. CLINICAL REPORT A 24-year-old woman attended with the chief concern of the unesthetic appearance of her maxillary anterior teeth. DENTAL HISTORY - revealed trauma to the maxillary anterior teeth 14 years back . Both maxillary central incisors were avulsed and had been immediately replanted into the sockets. She did not have any major concerns until recently noticing intruded central incisors and an unesthetic appearance.

12. The intraoral examination revealed that both central incisors were intruded by 3 to 4 mm and were retroclined .

13. A cone beam computed tomogram (CBCT) revealed destructed labial cortical bone and extensive internal resorption of both maxillary central incisors

14. The entire labial surface of the root of a right central incisor had been exposed with complete loss of labial cortical bone. The root of the left central incisor was almost completely resorbed, with a small remnant remaining in the alveolar ridge.

15. Treatment options for prosthetic replacement after the extraction of both maxillary central incisors were explored. The smile was designed using a digital smile design software program (DTS PRO 2D; Dental Treatment Simulation)

16. Factors that contributed to the complexity of the treatment procedures included her youth, high esthetic expectations, a high smile line, vertical bone deficiency, and soft tissue loss with a high gingival zenith of ankylosed maxillary central incisors. A conventional treatment plan would have been extraction and socket grafting followed by vertical bone and soft tissue augmentation for implant-supported prostheses .

17. Orthodontic osseous distraction was selected with implant-supported prostheses . Both central incisors were extracted under local anesthesia. An immediate interim fixed dental prosthesis was bonded to the maxillary lateral incisors for the initial healing period of 4 weeks.

18. Complete mouth fixed orthodontic treatment was initiated using 0.022″ slot ceramic brackets (MBT Clarity ADVANCED Ceramic Brackets; 3M) in both maxillary and mandibular arches. Orthodontic appliance to move lateral incisors mesially with pontics on archwire . B, Pontics modified to accommodate mesial movement of lateral incisors .

19. A new CBCT scan was made to evaluate the bone thickness around the newly positioned lateral incisors at the central incisor positions and at the edentulous spans created at the lateral incisor positions

20. Two 3×12-mm tapered implants (Tapered Internal implants; BIOHORIZONS) with healing abutments were placed in the lateral incisor positions. Interim restorations were fabricated with fixed screw-retained interim abutments and a heat polymerized acrylic resin and issued next day after implants placement.

21. After initial soft tissue stabilization, the digital smile design software program was reused. Both lateral incisors, positioned at central incisors, were prepared to receive porcelain laminate veneers.

22. Intraoral scans were made using scan bodies for the definitive restorations, and interim crowns were attached back to the implants. The definitive restorations were designed with a design software.

23. The laminate veneers were milled from a lithium disilicate. The screw-retained implant-supported crowns were designed and fabricated using Ti-base abutments. The milled crowns were cemented to Ti-base abutments extraorally and screwed on the implants. The laminate veneers were bonded to the lateral incisors using resin cement.

24. A.Intraoral view before delivery of definitive restorations. B, Restored gingival architecture with definitive restorations. C, Frontal view indicating esthetically pleasing appearance

25. DISCUSSION Extraction of both central incisors followed by orthodontic alveolar osseous distraction by mesial movement of the lateral incisors and placement of the dental implants in the space of the lateral incisors with a digital smile design approach were performed. The treatment plan was finalized after discussing risks, benefits, time, and cost factors with the patient. This unconventional treatment approach was preferred principally to maintain a long-term stable esthetic outcome in the mutilated maxillary anterior alveolar segment.

26. Orthodontic alveolar distraction facilitated the regrowth of healthy hard and soft tissues to support the implant prostheses. The definitive esthetic outcome was pleasing to the patient without the need of the additional procedures of prosthetic camouflaging or surgical bone augmentation. Conventional fixed dental prostheses might have needed pink porcelain in the pontic area to improve esthetics .

27. In patients with alveolar bone insufficiency, orthodontic alveolar osseous distraction allows healthy bone for fixed implant or tooth-supported prostheses. Healthy peri-implant bone, periodontium, and adjacent teeth provide a natural and favorable environment for implant restorations Bone grafting procedures have been commonly performed to regain bone volume for the implant-supported prostheses. However, less conventional treatment approaches to enhance predictable and healthy bone growth should also be considered.

28. This clinical report highlights such treatment approach to manage an esthetic zone in a patient with high esthetic expectations. Careful explanation of the rationale of such treatment needs to be emphasized to the patients, who should be made aware of the longer treatment.

29. conclusion The esthetic rehabilitation of the maxillary region after the removal of 2 ankylosed central incisors is presented. The lateral incisors were moved mesially to the central incisor positions, and implants were placed in the lateral incisors positions after new healthy bone had been induced. The overall esthetic outcome was pleasing, and the long-term, stable peri-implant tissue architecture was maintained.