COMPLEX MULTIDISCIPLINARY IMPLANT-ORTHODONTIC TREATMENT: ESTHETIC INVISIBLE ORTHODONTIC THERAPY COMBINED WITH IMPLANT SURGERY AND SIMULTANEOUS BONE AUGMENTATION
The present case report is aimed at presenting an implant treatment associated with both a simultaneous guided bone regeneration (GBR) and an orthodontic therapy. The complexity of the case required the use of a resorbable Bio-Gide membrane and a bone graft made up of autogenous bone together with Bio-Oss. Simultaneously, an esthetic orthodontic therapy was performed by means of ceramic brackets and miniscrews at the maxillary arch and using an invisible bracketless approach by means of preactivated retainers at the mandibular arch.
It is worth remembering that the type of membrane is a critical factor for the success of bone augmentation procedures. Nowadays, it is widely accepted that only non resorbable Gore-Tex membranes can guarantee a predictable result in complex bone reconstructions. Adequately stabilized resorbable membranes can be considered a viable alternative only in easier clinical cases and in the presence of a good regenerative potential. In order to properly stabilize resorbable membranes, nowadays resorbable pins are available (Resor Pin, Geistlich); differently, operative tips may be adopted, just like the use of membrane strips opportunely cut, as proposed by Prof. Massimo Simion, or creating a hole in the membrane so a sto stabilize it around the implant neck.
As to this clinical case, the patients lamented recurrent abscesses in region 14. First canine and molar class on both sides with a deep bite and mandibular crowding were evidenced.
A vertical radicular fracture of tooth 14 was noticed. Such tooth had been previously restored by means of a metal cast post and a metal-ceramic crown; consequently, the extraction of tooth 14 was compulsory.
In order to solve the orthodontic problems, buccal ceramic brackets were used at the maxillary arch together with mini-screws to make the opening of the deep bite faster. On the contrary, pre-activated retainers were used at the mandibular arch, in order to expand the intercanine distance and to line up the anterior mandibular teeth.
The choice of using brackets at the maxillary arch was due to the necessity of maintain a provisional resin shell in region 14. Such shell was fastened to the orthodontic wire by means of a metal ligature. In order to control the rotation of the resin shell, a continue ligature from tooth 13 to tooth 15 was made alternating the rotation spin mesially and distally to the provisional shell.
As we can also see in further cases in the present blog, to date it is preferable to avoid such a problem in the absence of teeth using rigid orthodontic wires lingually to fasten provisional crowns, so as to perform a bracketless lingual orthodontic therapy also in such cases.