Ortho Prostho
relationship
Prosthodontist referred
a patient for space
opening. On examination you found missing
lower right1st molar, mesialy tilted lower right
2nd molar.lower 3rd molar is absent on same
side.
1. Write down the mechanics of space opening.2.5
2. What are the problem associated with space opening? How you
will overcome this problem? 2.5
3. Write Retention protocol after space opening of this patient. 2.5
4. What are the advantages of space opening for this patient? 2.5
Problem associated with tilted
tooth
Pocket
Spacing
Crown root ratio
Mobility
Oral hygeine
HOW TO UPRIGHT INCLINED
MOLAR IN PREPARATION FOR
RESTORATIVE TREATMENT?
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APPLIANCE DESIGN
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A. Moderately mesially inclined molar with no distal drifting
of premolars :
1. Initial arch wire
The molar is tipped back into position.
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2. Finishing arch wire
Rectangular arch wire for buccolingual control.
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B. Moderately mesially inclined molar with distal drifting of
premolars :
1. Initial arch wire
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2. Second arch wire
Once mild uprighting has been achieved, rectangular wire (0.018
by 0.25 in.) and an open coil spring should be inserted.
This is not recommended unless the patient has distal tipping and
spacing of the premolars.
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C. Severely mesially inclined second molar :
Initial arch wire may be a T loop in 0.016 in round wire.
Now the first appliance can be utilized for finishing as necessary.
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D. Mesially inclined second and third molars :
The third molar should always receive the buccal tube.
1.
When using this appliance, it may be necessary to utilize several light,
multilooped, round arches to achieve the bracket alignment necessary
for rectangular arch engagement.
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ORTHODONIC PROSTHODONTIC
IMPLANT INTERACTION
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Definition :
An implant can be defined as, A graft or insert set firmly or deeply
into or onto the alveolar process that may be prepared for its
insertion.
A dental implant is defined as, A substance that is placed into the
jaw to support a crown or fixed or removable denture.
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Indications for implants :
Othodontic Anchorage
For completely edentulous patients with advanced residual ridge
resorption, where it is difficult to obtain adequate retention.
For partially edentulous arches where removable partial dentures
may weaken the abutment teeth and also provide reduced
masticatory efficiency.
For single tooth replacements where fixed partial dentures cannot
be placed.
Patients desire.
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Advantages of using implants :
Preservation of bone : The implant stimulates the bone like a
natural tooth thereby preventing the progress of residual ridge
resorption.
Improved function : Implants can be designed such that the effect
of harmful forces can be minimized. The chewing efficiency is
greater than other prosthetic replacements.
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Aesthetics : Implants provide a natural emergence profile
(appearance of the tooth as if it emerges directly from the soft
tissues).
Stability and retention : Implants are more stable and retentive
due to osseo-integration.
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Disadvantages of implants :
It is very expensive. Patient affordability is the primary concern in
the use of implants.
Cannot be used in medically compromised patients who cannot
undergo surgery.
Many patients do not accept longer duration of treatment and
tedious fabrication procedures.
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It requires a lot of patient cooperation because repeated recall
visits for after care is essential.
It cannot be universally placed due to the presence of
anatomical limitations.
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Adults presenting for comprehensive orthodontic treatment often
have dental problems that require restorative as well as orthodontic
treatment.
Such problems include loss of tooth structure from wear and abrasion
or trauma, gingival esthetic problems, and missing teeth that require
replacement with either conventional prosthodontics or implants.
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Problems Related to Loss of Tooth Structure :
The positioning of damaged, worn or abraded teeth during
comprehensive
orthodontics
must
be
done
with
the
eventual
restorative plan in mind. Early consultation with the restorative
dentist obviously becomes important.
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There are three particularly important considerations in deciding
where the orthodontist should position teeth that are to be
restored :
The total amount of space that should be created
The mesio-distal positioning of the tooth within the space
The bucco-lingual positioning.
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The orthodontic positioning obviously should provide adequate
space for the appropriate addition of the restorative material.
The ideal position may or may not be in the center of the space
mesio-distally. This would depend on whether the most esthetic
restoration would be produced by symmetric addition on each side
of the tooth, or whether a larger build-up on one side would be be
better.
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Similarly, the ideal bucco-lingual position of a worn or damaged
tooth would be influenced by how the restoration was planned.
If a crown or composite build-ups are planned, the tooth should be in
the center of the dental arch.
But if a facial veneer is to be used, the orthodontist should place the
tooth more lingually than otherwise would be the case, to allow for
the thickness of the veneer on the facial surface.
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Finally, better restorations can be done if the orthodontist
provides slightly more space than is required, so there is room
for the restorative dentist to finish and polish proximal
surfaces.
The slight excess space can than be closed with a retainer.
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A particularly distressing problem is created by gingival recession
after periodontal bone loss, which creates black holes between
the maxillary incisor teeth.
Even
if
periodontal
therapy
succeeds
in
obtaining
some
regeneration of the lost bony support, there is no way to regenerate
the missing soft tissue.
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One approach to this problem is to remove some interproximal
enamel so that the incisors can be brought close together. This
moves the contact points more gingivally, minimizing the open
space between the teeth.
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COMPREHENSIVE ORTHODONTICS
IN
PATIENTS PLANNED FOR IMPLANTS
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Major concerns when implants are to be placed are adequate
bone in the edentulous area to support the implant, especially
when the implant is to replace a congenitally missing tooth, and
for single-tooth implants, adequate space between the roots as
well as the crowns of the adjacent teeth.
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A successful implant requires adequate bone to support it. If there is
no tooth to erupt into an area of the dental arch, little or no alveolar
bone ever forms.
The result is a large defect in the alveolar process that can make
implant placement almost impossible.
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The orthodontic plan would be to open the edentulous space and
position the adjacent teeth after the permanent tooth has erupted
and to place an implant to support the prosthetic crown after the
vertical growth has completed.
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The timing of implant placement is particularly
critical for adolescents and young patients.
Implants to support the restorations should not
be placed untill all vertical growth has
completed.
Once the implant has been placed, no further
eruption of this tooth will occur, even though
the adjacent teeth continue to erupt in response
to increase in the patients vertical facial height.
The implant is analogous to an ankylosed tooth.
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PROSTHODONTIC
CONSIDERATIONS WHEN USING
IMPLANTS FOR ORTHODONTIC
ANCHORAGE
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Orthodontic treatment has been a valuable adjunct to prosthodontics
for decades.
Indeed, certain prosthodontic treatments are not possible or would
be severely compromised without preprosthetic orthodontic therapy.
This mutually beneficial orthodontic prosthodontic relationship has
been
significantly
enhanced
through
advancements
in
adult
orthodontic treatment.
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The use of implants for orthodontic anchorage can produce
superior preprosthetic tooth alignments.
However the prosthodontic advantages of using implants for
orthodontic anchorage are only fully realized when the location and
angulation of the implants are carefully planned so that they are
optimally located for prosthesis that will be placed after orthodontic
therapy.
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A.
Patient
has
extensive
vertical overlap of anterior
teeth.
Mandibular
incisors
are contacting palatal soft
tissue
to
create
gingival
trauma.
B. Six remaining mandibular
teeth are proclined facially
and malaligned. Because of
lack of posterior teeth for
orthodontic
anchorage,
retraction and realignment
of these teethwww.indiandentalacademy.com
cannot be
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C.
Mandibular
cast
shows
location
of
endosseous root form implants that have been
placed to provide posterior anchorage for
retraction and realignment of anterior teeth.
Implants are thereby located in position where
they
can
posterior
be
used
prosthesis
to
support
after
definitive
completion
of
orthodontic therapy.
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D. Cast showing one of the
orthodontic implant prosthesis that
provided orthodontic anchorage.
Anteriorly cantilevered pontic was
veneered
with
resin
and
orthodontic bracket bonded into
resin veneer.
E. Orthodontic treatment is nearing
completion.
Retraction of both
maxillary and mandibular anterior
teeth
has
improved
their
relationship, eliminated palatal soft
tissue trauma and improved facial
esthetics through changing lip
contours.
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Without use of mandibular posterior implants,
these
improvements
would
not
have
been
possible. Patient will soon be ready for definitive
prosthodontic
replacement
treatment
of
single
that
incisor
includes
crowns
and
fabrication of maxillary fixed partial dentures
from canines to first molars.
Mandibular posterior implants will be used to
support and retain posterior prosthesis.
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CONCLUSION
It would do well for all of us to keep in mind that orthodontics
cannot stand alone. We are after all dentists by profession. Thus it
is our moral obligation to assess not just the teeth but also the
surrounding structures . In this manner we elevate the standards of
not just orthodontics ,but of dentistry within and outside our
community.
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Thank You
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