This case shows a treatment combination of orthodontics, implants and prosthesis.
The patient lacks two molars on the lower jaw. She has moderate to advanced periodontal disease, occlusal plane with a deep Curve of Spee and produces an incredible amount of calculus in a short time. She is experiencing the effects of tooth loss and periodontal disease. These are rear occlusal collapse, mesial tilting of the remaining molars and gap opening due to lack of bone support and tongue thrust.
The molars could have been also extracted, but we decided to give them a chance. With the help of nearby implants and at a correct angle, their life expectancy will be extended and depending only on the evolution of the patient’s hygiene and the periodontal disease.
The lower incisors almost out of the bone and have a high degree of mobility. The decision was to replace them by implants after ortho. I used ortho treatment to flatten the occlusal plane, close the spaces and tilt the molars to vertical.
I didn’t use braces on the incisors for three reasons:
- They would be extracted
- No intrusion or further bone remodeling was needed
- I could afford crowding during the treatment because this would mean less space to cover with two implants.
Note that the upper occlusal plane flattened by itself, without ortho.
Implants are placed easily on the rear ends. 5×10” on the right and 4×11.5” on the left, brand 3i.
Regarding the incisors, I pulled them out and placed the implants immediately. Waiting for the gum to heal after extraction often produces great ridge collapse in these periodontal cases.
The with of the bone was enough for two 3.25×15” 3i implants.
I prefer not to use 3.25mm of 3i brand, if possible. The thread is too short and too many threads probably heat the bone a little too much. Failure happens more often than with regular thread implants. For me, the wider the thread, the better.
But I prefer not to try expansion in this case, as there is risk of fracture in any of the alveolus walls.
A removable, acrylic, partial denture is used as temporary and space retainer, while a fellow colleague works on the ceramic crowns.