0 Evaluation & Diagnosis
1 Treatment Planning
2 Progress & Completion

Patient cases:

Multi-unit restorations

(Maxilla / Mandible / Posterior)

Multiple implant placement followed by orthodontic treatment to intrude the over-erupted teeth

Lead:

Sebastian Horvath

A 33-years old female patient presented to the clinic with the desire to replace her missing teeth. The teeth had been removed years ago. The clinical evaluation revealed that the opposing teeth had moved into the gaps. The reduced vertical space made a prosthetic reconstruction impossible.

First the implants were placed by using a surgical guide. After three months, long-term provisional restorations were fabricated and fitted. These provisionals were used as anchorage for the intrusion of the elongated teeth. After completion of the orthodontic treatment (1year and 8 months), the final restorations were fabricated.

Evaluation & Diagnosis

Initial intra-oral frontal view. She presented with partial edentulism.

Initial panoramic x-ray. Missing teeth: upper right premolars, upper right first molar, upper left second premolar, upper left first molar, lower left first and second molars, lower right second molar. Root canal treatments: upper right central incisor, upper left second molar. Periapical radiolucent image on upper right canine.

Intra-oral right lateral view. Over-eruption of lower right second premolar and first molar. Missing teeth: upper right premolars, upper right first molar, lower right second molar.

Intra-oral left lateral view. Missing teeth: upper left second premolar, upper left first molar, lower left first and second molars.

Intra-oral maxillar occlusal view. U-shape.

Intra-oral mandible occlusal view. U-shape.

Treatment Planning

Maxillary surgical guide was used to let us place the implant in the most safe, accurate and predictable manner.

Mandible surgical guide

Progress & Completion

Intra-oral occlusal view of the upper right side. Missing teeth: premolars and first molar.

Intra-oral occlusal view of the upper right side. Surgical guide with the two holes to mark where the two implants will be placed.

Once the marking points were done, the surgical quide was removed. A flap was raised and the implants were placed.

Intra-oral occlusal view of healing cap and stitches.

Intra-oral occlusal view of the upper left side before placing the implants. Missing teeth: second premolar and first molar.

Intra-oral occlusal view of the upper left side. Surgical guide one single hole to direct the implant drilling system.

Intra-oral occlusal view of the implants placed after the points were marked and the flap was raised.

Intra-oral occlusal view of the healing cap and stitches.

Intra-oral occlusal view of lower right side, second molar is missing.

Intra-oral occlusal view after the implant was placed to replace the second molar.

Intra-oral occlusal view of healing cap and stitches.

Intra-oral occlusal view before placing the implant. Missing teeth first and second molars.

Intra-oral occlusal view after a flap was raised and the implant was placed.

Intra-oral occlusal view of healing cap and stitches.

A panoramic x-ray was taken after the multiple implant surgery.

Intra-oral occlusal maxillary view after the process of osseointegration.

Intra-oral occlusal mandibular view after the process of osseointegration.

Upper left side 3 months after implant placement.

The healing cap on the upper left implant was removed and a scanbody was placed to take a digital impression.

A long-term provisional crown was made and placed on the upper left implant.

Upper left second molar view.

The upper left second molar was divided into 3 sections to be able to remove it.

Once the tooth was extracted, the drilling implant system was started in order to be able to place the implant in the socket.

An immediate implant was placed in the socket of the upper left second molar.

BioOss was used to promote the maintenance of the ridge profile.

A resorbable collagen membrane was used as well, which can provide new bone formation and restore the hard tissue. Healing cap was placed afterwards.

Upper left second molar implant with the healing cap and stitches.

Panoramic x-ray after the upper left second molar was extracted and replaced with an immediate implant. Note that orthodontic brackets were placed on a few teeth to intrude the elongated teeth.

Intra-oral frontal view after all the implants and brackets were placed.

Orthodontic brackets were placed and the provisional crowns were used as anchorage for the intrusion of the elongated teeth.

Orthodontic brackets were placed and the provisional crown was used as anchorage to avoid the over-eruption of the lower left wisdom tooth after the opposing tooth was extracted.

Intra-oral occlusal view of the upper left side. We can see the provisional crown and the healing cap.

A coil spring was used to avoid mesial movement of the upper left wisdom tooth after the extraction of the second molar.

Panoramic x-ray after the orthodontic treatment was completed. We can see the over-erupted teeth are at the same level now compared to the adjacent teeth.

Intra-oral frontal view after the orthodontic treatment was completed.

Intra-oral left lateral view after the orthodontic treatment was completed. Note that the lower second premolar is no longer over-erupted.

Intra-oral right lateral view after the orthodontic treatment was completed. Note that the lower second premolar and lower first molar are no longer over-erupted.

Intra-oral occlusal maxillary view after the orthodontic treatment was completed. Provisional crowns are in place except the upper left second molar implant that still has the healing cap.

Intra-oral occlusal mandibular view after the orthodontic treatment was completed. All provisional crowns are in place and ready to have the final crowns fitted.

Intra-oral occlusal view of the upper right side. Healing caps were removed to take impressions.

Intra-oral occlusal view of the upper left side. Healing caps were removed to take impressions.

Upper study model with the final crowns.

Lower study model with the final crowns.

Final panoramic x-ray.

Final intra-oral frontal view.

Final intra-oral right lateral view.

Final intra-oral left lateral view.

Final intra-oral maxillary occlusal view.

Final intra-oral mandible occlusal view.

Final intra-oral occlusal view of the upper right side.

Final intra-oral occlusal view of the upper left side.

Questions

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12.01.2021 | 20:49

what is the flash you are using?

Spectacular work and mazing multidisciplinary approach.

May I ask two questions

what is the flash you are using?

and what is the size if the suture you are using?

thank you

No answers yet

Answer

Show Answers

Spectacular work and mazing multidisciplinary approach.

May I ask two questions

what is the flash you are using?

and what is the size if the suture you are using?

thank you

Hide answers

08.04.2024 | 14:18

Where is the final outcome?

i have a similar case with orthodontic treatment and final prosthesis

No answers yet

Answer

Show Answers

i have a similar case with orthodontic treatment and final prosthesis

Team members

Specialist in Prosthetics

Orthodontist

Claus Peter Schulz

Dental Technician

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