|Year : 2011 | Volume
| Issue : 2 | Page : 93-96
Improving dental occlusion and esthetics with implants
Laxman P Rao, Gundu Maheshwar, Chimmiri Venumadhav, Anjana Raut
Department of Prosthodontics, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India
|Date of Web Publication||30-Dec-2011|
Kalinga Institute of Dental Sciences, KIIT Campus -5 Bhubaneswar-751024
| Abstract|| |
Generally implants are considered to restore the masticatory function, occlusion, and esthetics once the natural teeth have given up their job in the masticatory system. Today implants are considered for partially edentulous and completely edentulous situations, in order to give greater advantages and benefits over the removable prosthesis, for patients. According to the scientific literature review there is no conclusive option or parameters available on the subject of implant occlusion. Implant occlusion is the result of the surgical placement of implant and prosthetic designs, but this never happened to be a goal What type of occlusion is still an ambiguity, present whenever we are restoring cases with implants. This case report illuminates the fact that an implant can be used to correct the malocclusion associated with natural teeth, irrespective of whether or not scientific literature has cited what type of occlusion is planned on an implant prosthesis, in cases where multiple implants are used and complex procedures are undergone. However, this case report stands as a witness to the fact that an implant can change the occlusion / correct occlusion.
Keywords: Immediate loading, implant occlusion, malocclusion
|How to cite this article:|
Rao LP, Maheshwar G, Venumadhav C, Raut A. Improving dental occlusion and esthetics with implants. J Dent Implant 2011;1:93-6
| Introduction|| |
The placement of implants immediately or shortly after tooth extraction has proven to be a predictable treatment strategy with a very high rate of success. ,, Immediate implant placement has several advantages, such as, reduction of the number of surgical treatments, reduction of the time between tooth extraction and placement of definitive prosthetic restoration, and preservation of the alveolar ridge, in terms of height and width, which in turn has esthetic and functional benefits. 
| Case Report|| |
A 25-year -old female patient reported to the clinic with a complaint of an unesthetic crooked front tooth. On intraoral examination of the patient showed that no other unpleasant malocclusion was present, except for one tooth, which was lingually locked [Figure 1]. The patient insisted and was very particular that treatment time for correction of the malocclusion should be definitive and less time consuming, because of familial and career reasons. From the aspect of conservative and preventive dental practice we looked for all the options available and explained to the patient the physiological movement of the tooth by orthodontic correction. For all the conservative options the time factor was a hurdle, therefore, immediate implant placement after extraction of the malposed tooth and subsequent restoration with a zirconia crown was the treatment option given to her, and executed with her consent.
Intraoral periapical radiographs, lateral cephalogram, and an orthopantomogram (OPG) were advised in order to assess the skeletal patterns of the patient. Diagnostic models were prepared. Mesiodistal space analysis was performed on the maxillary anterior portion, and the emergence profile of the malposed and crooked tooth (left permanent central incisor) were assessed. Root anatomy of the misaligned permanent left central incisor, in terms of width and length, were assessed, to select the prospective implant. A diagnostic wax-up was done after mock surgery on a maxillary cast (trimming of the permanent lateral incisor on the cast). The esthetic outcome was discussed with the patient with the help of the diagnostic wax-up, with regard to occlusion and anterior guidance on the mounted maxillary and mandibular casts.
It was decided to prosthetically rehabilitate the patient with an implant-supported, cement-retained, fixed prosthesis, irt #9. The patient was advised to undergo all surgical clearance tests. Her reports revealed no significant findings.
Under local anesthesia infiltration the locked lingually placed tooth was extracted atraumatically [Figure 2]. A 4 mm diameter and 12 mm length (Bio-Horizon) screw-type endosseous implant was directly guided into the extracted socket of the left lateral incisor without any incision or flap elevation [Figure 3] and [Figure 4]. The implant site was prepared with standard drills, using the bony walls as a guide; no countersinking was carried out. After implant site preparation, a periodontal probe was used to explore and estimate the integrity of the bony walls of the alveolus. The implant site was carefully evaluated for evidence of bone fenestrations, bone dehiscences or peri-implant bone defects. This implant system provided the condition of placing the implant along with the abutment that helped the operator to assess the abutment emergence from the socket. Meticulous care was taken in terms of angulation, so that the implant abutment was labially placed to correct the problem associated with the lingually locked extracted tooth. The bone graft was packed coronally around the implant in a palatal aspect. The abutment attached implant was placed along the directions of the adjacent tooth. The implant placed showed good primary stability. Immediate temporization was done.
The post surgical healing period was uneventful. The soft tissue healing and morphology were considered clinically acceptable. After two weeks, an elastomeric impression was made and the master / definitive cast was prepared. It was decided to prepare the prosthetic crown with the Zirconia-based, all-ceramic restorations (ZIRCONZA). The wax pattern was fabricated, invested, and cast. The framework was tried in the patient's mouth and after confirmation of the frame fit, it was sent to the laboratory for ceramic restoration and firing.
The completed prosthesis was evaluated for margin integrity, occlusal relationship, function, esthetics, and phonetics. The timing of contacts was maintained and also a light secondary occlusal contact was established on the implant-retained zirconia crown. The patient has been followed regularly for routine hygiene and evaluation of long-term success of the restorations. She has continued to report excellent comfort and function and is pleased with the treatment outcome [Figure 5].
| Discussion|| |
A cross-bite exists when the mandibular teeth lie more buccal to the maxillary antagonist in centric occlusion. The severity may vary from a single tooth to a whole quadrant. In the present case, there was no obvious functional disturbance, but it was an esthetic concern to the patient. Traditional techniques to correct a cross-bite vary from the use of a simple removable appliance to surgical-assisted expansion of the maxilla with a postoperative, orthodontic, appliance-based treatment, depending on the severity. Conventional techniques to correct malocclusion and esthetics also require patient cooperation and commitment. Early correction of a cross-bite can prevent the need for more difficult treatment in adulthood, where growth would have ceased and the dentition is more likely to be heavily restored.
In the case described, the patient declined any orthodontic intervention. The initial planning was based on a solely restorative approach, to improve function and esthetics. Correction using an implant-supported prosthesis was chosen as the most acceptable option.
Therefore, implants are not only considered for replacement, but can also be used to correct single tooth malocclusions in a rapid and definitive manner, provided important measures are taken to maintain correct angulation during placement. In this case report malocclusion and an unpleasing appearance has been successfully addressed with placement of implants and restoration with zirconia crowns. During the course of lengthy treatments, the stabilization of the corrected malocclusion requires clinician intervention and patient cooperation.
The placement of an implant immediately after tooth extraction can sometimes result in a defect between the implant surface and the surrounding bone walls. Schwartz-Arad and Chaushu have reported a successful clinical outcome for nine single implants placed immediately after tooth extraction, without incision or primary flap closure.  On the contrary few authors have recommended the use of barrier membranes to obtain bone regeneration. ,, However, the use of barrier membranes may be associated with clinical complications such as bacterial colonization, infection and impaired bone healing. Celletti et al. investigated the effects of guided bone regeneration procedures in experimental animals and concluded that the greatest bone gain was in the sites not protected by membranes.  The need for a barrier membrane should therefore be carefully evaluated. More recently some authors have demonstrated - through a histological analysis - that implants placed immediately after extraction, without any regenerative procedures could heal like implants placed in healed or mature bone. 
| Conclusion|| |
The case presented illustrates how implants provide new options for adult patients with both orthodontic and restorative problems. The placement of an endosseous implant in this case, has facilitated the correction of a single tooth malocclusion within a limited period of time. From a restorative aspect, implants do provide a definite treatment option in certain clinical situations.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]