DR.

MUHAMMADASIM RESIDENT(ORTHODONTICS) SBDC,PESHAWER

Adult pts missing teeth compromised anchorage Implants are required for future prothesis.
Implants are placed before orthodontic treatment. Initially for anchorage After, as abutment for fixed prothesis

Age;30yr Extracted teeth Anterior crossbite Skeletal ClassIII malocclusion Consultation with a team of specialists
Treatment plan Leveling and alignment,uprightening & intrusion of mand. 3rd molars Orthognathic surgery to correct skeletal deformity Fixed prothesis

Ti- implants were placed bilaterally in mandible,mesial to 3rd molars. Buried in soft tissue for 6 months Implant location
Diagnostic wax set-upto pre-determine the width of pontics and molar

abutments

Position; parallel to the long axis of 1st premolar

After 6months Implants were uncovered Abutments were placed & composite crowns constructed Composite Bracket placement level with the occlusal plane of premolar.

NiTi wire inserted into 3rd molar

After 8months Molar was uprighted & intruded Implants were then prepared and used as abutment for fixed bridges between premolars and implants

46 yrs pt with missing several posterior teeth in mandible Moderate Crowding + incisors were in edge-to-edge relationship LR7 had ClassIII furcation defect with significant bone loss on mesial side
Objective Retract mandibular incisors Level and align upper arch Correct o/j & o/b Left Sufficient space for pontics

Strategy Ext molars, replace with implants Retract incisors with implants
Treatment sequence Implant placement plus provisional crowns
Diagnostic wax set-up..to simulate the future position of teeth

Level & alignment of upper incisors Retract lower incisors via elastomeric chains Sufficient space was left for pontics and abutments Fixed prothesis

50 yr old woman with several posterior teeth missing Over-eruption of upper molars & premolarsinsuffient space for lower pontics. Primary objective
To Intrude the over-erupted teeth

Strategy
Intrusion via Repelling magnetic force

Implant placement Plastic stage was placed over mandibular abutments Samarium cobalt was placed in the occlusal surface of plastic stage

A removable segmental stent containing a magnet was placed over the maxillary teeth When magnets were brought into contact,repelling force intrude the upper teeth but ont implants. To achieve maximum magnetic force
Acrylic splint contacting remaining teeth Intermaxillary elastics during sleep to keep teeth together and magnets in

contact As molar intruded,adjust splint

After 8 months 3mm intrusion of molar & premolars

Factors affecting the success of implant when used for anchorage Treatment planning
interdisciplinary approach Restorative dentist,periodontist,oral surgeon,orthodontist Carefuly determine the position of implant

Location of implant
Should be determined carefully Diagnostic wax set-up

Plastic placement guide

Timing of implant placement In most cases,before orthdontic treatment Occasionally, during treatment
When tooth movement on either side of implant is unpredicted

Age of patient non-growing pts(M>19yrs:F>14yrs) If placed in growing pts

Teeth will erupt while implant not Vertical discrepency between teeth and implant

Insufficient buccolingual width on bone

1st option Implant placement,allowing thread of implant to be exposed on buccal Freezed dried de-calcified bone placed over threads Polytetraflourethylene membrane is positioned over bone Close flap After 6-8 weeks Membrane is removed & soft tissue flap is placed directely on implant

2nd option Increasing width of alveolus before implant placement Expose bone Place freeze-dried decalcified or autogenous bone Cover with polytetraflouroethylene membrane Implant placement

Time duration b/w implant placement and orthodontic force application

Usually 4-6 months in mandible Represents the the amount of time required by the body to initially deposit and then remodel bone around implant

Non-lamellar bone.remodeling.secondery osteon

Restoration During orthodontic tooth movement, provisional crown should be placed on implant to allow attachment of bracket Size of crown is determined from diagnostic wax set-up Final restoration If prothesis is attached only to implant, it can be restored immediately after orthodontic treatment If prothesis will attach to teeth also , then wait for at least 6months(teeth are mobile at the end of orthodontic treatment)

THANKS