Generating Labial Bone for an Orthodontic Implant

Generating Labial Bone for an Orthodontic Implant 

Orthodontics - February 15, 2014 - Vol. 28 - No. 2

Labial bone may be created for an implant by orthodontic lingual movement.

Background: In cases where nonrestorable teeth are to be replaced by implants and there is inadequate bone for the implants, orthodontics has been shown to be an effective method to enhance bone support. The technique of orthodontically extruding a nonrestorable tooth typically decreases the socket diameter and depth with bone apposition in the interproximal and periapical areas adjacent to the orthodontically extruded tooth. Extrusion has also been shown to increase the zone of attached keratinized gingival tissue. The end result is that a better environment is created for an immediate implant placement. At times, labial bone is lacking, and extrusion has not been shown to be effective in adding bone in that dimension. Is there a way to modify the orthodontics to enhance the alveolus labially?

Objective: To orthodontically develop bone apically and labially at the potential implant site.

Design/Methods: This was a clinical report of a single case in which the typical orthodontic extrusion technique was altered to apply both an extrusive force and a lingual force to the nonrestorable tooth. The subject was a 41-year-old male with a nonrestorable maxillary right central incisor. The unrestorable tooth was extruded and moved lingually with fixed appliances for 5 months. The tooth was extracted and an immediate implant was placed. A graft was also placed on the labial using guided bone regeneration techniques. Four years later, a cone beam CT was taken to evaluate the tissues surrounding the implant.

Results: The additional labial bone remained intact, and the implant was judged to have an excellent long-term prognosis. The increased gingival thickness on the labial aspect and the improved tissue biotype were also maintained.

Conclusions: The volume and height of the labial bone and labial gingival tissue and biotype were enhanced. The osseous site for a guided bone regeneration technique is improved by this technique.

Reviewer's Comments: Even though this was a single case report, the authors suggested that additional bone generation on the labial can occur by orthodontic movement to the lingual. This technique is potentially very useful clinically, as occasionally the alveolar bone is inadequate for proper implant placement. I look forward to additional and ideally long-term reports on this interesting technique.(Reviewer–John S. Kanyusik, DDS, MSD).

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