JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 90-93

Rehabilitation of a congenital missing lateral incisor by interdisciplinary approach using orthodontic intervention and implant placement


Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College, Nagpur, Maharashtra, India

Date of Web Publication21-Dec-2017

Correspondence Address:
Dr. Vaishakhi Yeshwant Baisane
501/A Wing, Green Park Complex, OPP YCCE, Wanadongri, Nagpur - 441 110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_9_17

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   Abstract 


Missing tooth due to congenital absence or traumatic dental injury can cause functional and sociopsychological consequences in the younger population. The treatment modality chosen can impact their well-being during their formative years. Regardless of the high success rate in adults, implant placement in young patients is not common due to its ankylosed nature and concerns with possible later occurring infraocclusion. This case report addresses management of a missing anterior tooth by conventional orthodontic treatment along with implant placement and prosthesis, acknowledging the fundamental considerations by a team approach.

Keywords: Congenitally missing lateral incisor, implants, orthodontic intervention


How to cite this article:
Baisane VY, Bhutada GP, Borkar SP, Maheshwari SA. Rehabilitation of a congenital missing lateral incisor by interdisciplinary approach using orthodontic intervention and implant placement. J Int Clin Dent Res Organ 2017;9:90-3

How to cite this URL:
Baisane VY, Bhutada GP, Borkar SP, Maheshwari SA. Rehabilitation of a congenital missing lateral incisor by interdisciplinary approach using orthodontic intervention and implant placement. J Int Clin Dent Res Organ [serial online] 2017 [cited 2019 Dec 13];9:90-3. Available from: http://www.jicdro.org/text.asp?2017/9/2/90/221398




   Introduction Top


Tooth loss due to congenital absence is common and causes significant functional and psychosocial problems in youth with maxillary lateral incisor being the second most commonly absent tooth. Dental implant placement to replace missing tooth has been documented to be a predictable treatment modality with high success rates. Proper case selection and correct sequence of following treatment plan results are essential for desirable outcomes. When planning for the placement of an implant, it must be ensured to have adequate space between the crowns and roots and also between the proposed fixture and adjacent roots. This report presents a case wherein space due to congenitally missing lateral incisor was treated with orthodontic intervention and implant placement, a multidisciplinary approach of which a few cases have been till date reported.


   Case Report Top


A 22-year-old female patient reported to Department of Periodontology, complaining of spacing in the maxillary anterior region of the jaw. Extraoral examination showed a straight profile with competent lips. Intraoral examination revealed Angle's Class I molar relationship with spacing in maxillary anteriors and congenitally missing maxillary right lateral incisor. Also observed was the mesially drifted maxillary right canine and distally drifted maxillary right central incisor. Spacing was evident between all teeth maxillary anterior sextant with healthy periodontium [Figure 1]. The treatment chosen was orthodontic correction followed by implant placement with provisionalization before permanent restoration to guide the healing process and conserve the esthetics. The patient was informed about the treatment, and consent was obtained regarding the same.
Figure 1: preoperative intraoral examination – maxillary arch images show spacing in the right view due to the absence of permanent maxillary right lateral incisor

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On model analysis, the space available was 5 mm and required space (mesiodistal width of lateral incisor) was 7 mm. Treatment objectives were to correct spacing, midline shift, and create space for replacement of the tooth. Hence, the case was treated using MBT appliance with 0.022 slot. Alignment and leveling were achieved in 4 months on initial archwire (0.014 NiTi, 0.016 SS) and closure of extraction space on higher dimension wire. Intrusion of upper anterior segment was done by Connecticut intrusion arch (0.016 × 0.022 SS). Finishing was done using on 0.019 × 0.025 TMA wire [Figure 2]. Retention phase was carried out after the implant placement.
Figure 2: intraoral examination postorthodontic treatment shows the optimum space formed for implant placement

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After administration of local anesthesia, the surgical site was exposed and initial drilling was done for subsequent site preparation using 2, 2.8, and 3.2 mm drills. Alpha-dent™ implant-sized 3.75 mm × 13 mm was placed, fixed into the bone and tightened with a wrench. Sutures were placed and the patient was recalled after 48 h for postoperative checkup, upon which uneventful healing was observed. Seven days later, checkup was done and sutures were removed. After 1 month, healing screw was removed and replaced with healing cap, which was kept for 15 days.

Nonloaded provisional prosthesis was planned, to guide the soft tissue healing process and conserve esthetics in the anterior region. Impression was made with elastomeric impression material, and laboratory analog was transferred to the master cast. Straight abutment was adjusted and tried in the patient along with provisionalization. The retention phase was carried out up to 6 months for maintaining the space. Six months after provisionalization, permanent crown was fabricated, tried, and cemented, whereby fine esthetic results were achieved [Figure 3]. The patient was recalled up to 1 year for periodontal maintenance at periodic intervals which ensured that both the implant and the prosthesis were in proper condition.
Figure 3: implant placement followed by prosthesis placement shows the implant placement procedure along with prosthesis placed, the preoperative, after orthodontic intervention, and postimplant placement orthopantomogram views

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   Discussion Top


Dental implants are an appropriate treatment option for replacement of missing maxillary lateral incisor teeth in adolescents after their complete dental and skeletal development. In this case, initial orthodontic management was crucial to obtain sufficient mesiodistal width. This space closure was achieved in 4 months followed by implant placement.

Several long-term researches have shown that the success rate of the osseointegrated implants reaches almost 100%.[1] The quantity and quality of alveolar bone as well as soft tissues around the implant must be assessed cautiously before considering implant placement in the esthetic zone.[2] To accommodate a standard implant in the maxillary lateral incisor area, there should be a minimum of 10 mm of coronoapical bone, 6.0 mm of mesiodistal bone present, and at least 6.0 mm of labiopalatal bone.

In this case, alveolar bone was available in maxillary lateral incisor areas in the labiopalatal and coronoapical dimension. However, there was deficiency in mesiodistal dimension which was treated othodontically. The average implant platform, which is 4.0 mm wide, requires mesially and distally, a space of 1.0 mm each between the platform and the adjacent tooth for proper healing and the development of a papilla postoperatively.[3],[4] Thus, a minimum of 6 mm of space for the lateral crown is required. In this case, after model analysis, it was noticed that the available mesiodistal space was 5 mm while that required was 7 mm. This 2 mm of mesiodistal space was achieved orthodontically. Second, average dental implant fixture is 3.75 mm wide, and 1–2 mm of space is necessary between the fixture and adjacent roots.[5] Typically, between 6 and 8 mm of bone between the central incisor and canine roots is recommended, which in this case available was 5 mm while that required was 8 mm, which was achieved along with gaining of mesiodistal width.

The goal of orthodontic alignment is to achieve optimum bone between the roots to place the implant and also that central incisor and canine roots should be parallel to slightly divergent to avoid complications resulting from proximity of the roots.[6] Once the central incisor and canine have been positioned orthodontically to create mesiodistal space between the crowns and roots of the teeth, orthodontic retention is essential for space maintenance. Therefore, the implant placed was followed by the retention phase for 6 months for maintaining the space achieved after which the permanent prosthesis was placed. The patient was recalled for periodontal maintenance up to 1 year to assess outcomes, and satisfactory results were observed.


   Conclusion Top


Discussing the case with different dental speciality professionnels leads to better treatment planning. Orthodontic intervention before placement of implants as in the present case for achieving optimum space helps in ideal implant placement and thereby successful outcomes. Interdisciplinary approach provides better treatment options which result in long-term successful outcomes and greater patient satisfaction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Belser UC, Schmid B, Higginbottom F, Buser D. Outcome analysis of implant restorations located in the anterior maxilla: A review of the recent literature. Int J Oral Maxillofac Implants 2004;19 Suppl: 30-42.  Back to cited text no. 1
    
2.
Richardson G, Russell KA. Congenitally missing maxillary lateral incisors and orthodontic treatment considerations for the single-tooth implant. J Can Dent Assoc 2001;67:25-8.  Back to cited text no. 2
    
3.
Spear FM, Mathews DM, Kokich VG. Interdisciplinary management of single-tooth implants. Semin Orthod 1997;3:45-72.  Back to cited text no. 3
    
4.
Balshi TJ. Osseointegration and orthodontics: Modern treatment for congenitally missing teeth. Int J Periodontics Restorative Dent 1993;13:494-505.  Back to cited text no. 4
    
5.
Shroff B, Siegel SM, Feldman S, Siegel SC. Combined orthodontic and prosthetic therapy. Special considerations. Dent Clin North Am 1996;40:911-43.  Back to cited text no. 5
    
6.
Ong MA, Wang HL, Smith FN. Interrelationship between periodontics and adult orthodontics. J Clin Periodontol 1998;25:271-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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