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This case shows a treatment combination of orthodontics, implants and prosthesis.
The patient lacks teeth on the lower jaw, pieces 47, 46, 45, 36, 42 and carries a one-pillar bridge over 42, 41. Due to previous crowding, she had a lower incisor extracted.
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I used a quick ortho treatment lo help alignment and. After extracting the lower left wisdom tooth (48), I corrected the first molar (46) angle, tilted forward after several years edentulous space.
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Implants are placed easily on the rear ends. But the space available on the incisors is always more critical. So, first I cut the bridge and, then, I open the flap.
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I run a set of expanders, since the ridge is rather narrow.
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The bone’s concave shape in this region forces the implant to be inserted in a different angle than the adjacent teeth in order to avoid thread exposure of the implant.
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The implant is set in place, to the limit of bone elasticity for a 3.75x15mm implant. I prefer not to use 3.25mm of 3i brand, if possible.The thread is too small. Too many threads probably heat the bone a little too much and failure happens more often than with regular thread implants. For me, the wider the thread, the better.
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I put the flap back in place with stitches and let the implants heal.
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I remove the braces and use a thin, temporary clear splint for retention, to prevent the spaces from collapsing,  while a fellow doctor works on the fixed prosthesis.
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When the prosthesis are finally fixed, I substitute the clear retainer for a new, thicker one, including the implant crowns.
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Final result. Note the different level of the gingiva in the incisors. Fortunately, This effect can’t be seen while talking. Now it would be time to start treatment in the upper jaw, to get better esthetics.
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