by Dr. Nadia Abazarnia, DDS
Orthodontics can be used to develop the peri-implant site prior to implant placement. Orthodontic treatment for children and adults can involve management of teeth missing due to agenesis, trauma, or extraction following dental disease or malformation.
An interdisciplinary approach between the dentist and orthodontist, and often the implant surgeon and prosthodontist, is usually required to formulate the most appropriate treatment plan for the patient. A decision usually needs to be made as to whether the space or spaces should be closed orthodontically, or maintained for eventual prosthetic replacement.
Over the last decade the reliability, predictability and long term success rate of implants has made them the prosthetic replacement of choice, especially when the teeth adjacent to the space are well formed and unrestored. When it is planned to incorporate implants into the orthodontic and restorative treatment plan, growth considerations, implant space requirements and implant site development are three of a number of treatment planning factors that need to be considered.
Growth Considerations: It is not usually appropriate to place an implant until completion of dento-alveolar development and skeletal growth. Throughout active growth the implant responds like an ankylosed tooth while the adjacent teeth continue to erupt, creating a discrepancy between the gingival margin of the implant and the natural teeth. Particularly in a patient with a high lip line, this will produce a poor aesthetic result unless implant treatment is delayed until growth has been completed. Chronological age alone is not accurate in determining whether growth has been completed for an individual. We expect that most girls will have completed the majority of their active facial growth by 16 years of age and boys by 19 years of age. However, boys in particular can show significant late facial growth. Radiographic examination can help to determine whether active facial growth has been completed.
Although active facial growth may be considered to have been completed in the late teens or early twenties, continued facial maturation and changes, including in the vertical dimension, continue throughout the individual’s life. The space required for implant and crown replacement will be determined by a number of factors including the size and shape of the contralateral tooth, the size of adjacent and opposing teeth, aesthetics, the occlusion and by the size of the implant to be used.
In some situations the orthodontist may be forced to create more or less than the ideal space required for the implant due not only to the size of the teeth but also in order to establish normal overjet and overbite. Options to be considered, in consultation with the restorative dentist or prosthodontist, are whether adjacent teeth need to be increased in width using adhesive restorations, veneers or crowns, or whether the width of the teeth needs to be reduced by interproximal stripping and crown recontouring.
The incorporation of orthodontic therapy into comprehensive treatment planning is a valuable adjunct which can enhance aesthetic and functional outcomes in restorative dentistry.
Reference ; Australian society of orthodontists