Uprighting a mesially tilted mandibular left second molar with anchorage from a dental implant

Abstract

Mesial tilting of adjacent teeth may appear after the removal of a tooth, leading to a lack of restorative space. This dental technique presents a method of uprighting a mesially tilted adjacent tooth by using a dental implant as anchorage.

Mesial tilting of adjacent teeth may appear after the removal of a tooth, leading to a lack of restorative space. Minor tooth movement (MTM) will regain the space needed for the restoration. Implant anchorage is a rapid, efficient, straightforward, and convenient tool for MTM. Since the 1980s, when Brånemark et al and Roberts et al published articles on the use of titanium implants for orthodontic anchorage, miniscrew implants (MSIs) have been extensively used. Generally, the MSI has been used for enhancing vertical and sagittal anchorage during orthodontic treatment. It is also a useful tool for MTM such as uprighting or intruding a molar tooth before restoration.

A conventional dental implant, which will be used for the eventual restoration of the missing tooth, provides alternative anchorage for MTM after osseointegration, avoiding additional implant surgery. This dental technique presents a new method of uprighting a mesially tilted adjacent tooth by using a dental implant for anchorage.

Technique

A 24-year-old woman presented to the Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, with the loss of her mandibular left first molar ( Fig. 1 ). The residual root of the mandibular left first molar had been extracted 1 year previously. A cone beam computed tomography (CBCT) image showed that the minimum mesiodistal dimension between the mandibular left second premolar and the mandibular left second molar was 6.2 mm ( Fig. 2 ). The 3-dimensional space was deemed inadequate for a normal-sized restoration.

Figure 1
Timeline of treatment included 6 months for osseointegration and 2 months of MTM. Time nodes included insertion of implant, extraction of maxillary left third molar and mandibular left third molar, start of MTM, finish of MTM, and delivery of implant-supported crown. Time for each segment, 1 month.

Figure 2
Cone beam computed tomography image of mandibular left second premolar to mandibular left second molar before insertion of implant. A, Sagittal view. B, Coronal view. C, Transverse view.

The procedure was as follows:

  • 1.

    Place an implant (Nobel Active, diameter 4.3 mm, length 10.0 mm; Noble Biocare) and assess stability. In this patient, 6 months was allowed for osseointegration. At that time, because of additional tilting, the minimum mesiodistal dimension between the mandibular left second premolar and the mandibular left second molar was 5.6 mm ( Fig. 3 ).

    Figure 3
    Mesially moved and tipped mandibular left second molar. A, Buccal image. B, Radiograph.
  • 2.

    Connect an implant abutment (diameter 3.5 mm, height 5.5 mm, 0°; Noble Biocare) to the implant.

  • 3.

    Bond a buccal tube (Shinyle) to the buccal surface of the mandibular left second molar.

  • 4.

    Insert the distal part of a stainless-steel wire (Ortho Organizers Inc) segmental arch with an open vertical helical loop and tip back bend ( Fig. 4 ) into the buccal tube. Clasp the mesial portion of the wire on the distal portion of the implant abutment. Activate the open vertical helical loop and increase the tilt angle of tip back bend each month.

Jan 12, 2020 | Posted by in Prosthodontics | Comments Off on Uprighting a mesially tilted mandibular left second molar with anchorage from a dental implant
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