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Minimal lingual appliance in combination with an Ortho implant: a preliminary report
Golan I., Baumert U., Müßig D., Germany
www.lingualcourse.com Vol. 1 No.4 Nov 2003
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A 19-year-old woman came to our clinic for orthodontic consultation. Her main concern was the unaesthetic color of the right upper canine. Her medical history was not remarkable, and she was referred to us by her dentist of care. Her facial form was ovoid and symmetric, with an orthognathic harmonious profile. Her TMJ condition was without pathology, and their function was within normal limits. She presented with an Angle Class I malocclusion with a retained maxillary right primary canine. (Fig 1). Radiographic inspection showed the location of the impacted successor. (Fig 2). No further pathology was noted.
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Fig. 1. Left and right: persistent upper right deciduous canine |
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Fig. 2. Displaced Canine on Cephalogramm |
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The patient rejected the proposed labial appliance for aesthetic reasons, insisting on the use of as little hardware as possible. A stable anchorage-polygon was necessary since the ectopic canine had to be forcibly erupted and pushed towards the primary canine. Since only minimal alignment of the rest of the dentition was necessary, we favored a minimal lingual appliance with an Orthodontic implant as anchorage (Fig 3). |
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Fig 3. Straumann Ortho-Implant |
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The Straumann Orthodontic Implant
Orthodontic implants are designed to be placed in the median palatal region and provide maximal anchorage in the maxilla. Typical applications are posterior anchorage for the retraction of anterior teeth (e.g. Angle Class II), as well as anterior anchorage for the distal or mesial realignment of molars. Ortho implants can also be used for maximal retromolar anchorage in the mandible, i.e. support for anchoring teeth with a lingual wire. The implant bed is prepared with cutting instruments matched to the implants. Primary stability after insertion of the orthodontic implant is an essential precondition for the successful integration of the implant.
A comprehensive orthodontic and implantology patient evaluation, preoperative diagnosis, and treatment planning must precede the surgical insertion of the implant. In this way difficulties and mistakes in the implantation are minimized or avoided, and proper orthodontic mechanotherapy can be planned and executed. Cephalometric analysis of the lateral radiograph is used to determine the length of the implant to be used. For precise case planning, a drill template was produced from a master cast, which was in turn used as an aid for positioning the implant in the patient. (Fig 4).
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Fig. 4. Drill template as an aid for positionng the implant on the patient |
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Surgical procedure
Under local anesthesia the palatal mucosa was removed with the aid of a mucosa trepine and an elevator (Fig. 5). The now exposed osseous implantation site was marked with a round bur which is used to score the cortical bone. The implant bed was prepared using the corresponding profile drill which should be sunk into the bone to achieve a complete seat. The Orthodontic inserting device was then put in place and the implant was inserted in the predrilled implant bed, which was then screwed as far as possible by hand and completed with slow rotational movements of the ratchet until it reached its final position (Fig. 6). The implant was closed with a healing cap attached by an Ortho healing screw until the healing was completed (Fig. 7). Excessive heat built-up should be avoided by adhering to sound drilling procedures. |
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Fig.5. Mucosa trepine and elevator
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Fig. 6. Ratchet
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Fig. 7. Left: Ortho healing cap;
Right: Ortho healing screw |
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During the 12 week implant-healing phase, treatment was arranged so that the Ortho implant is not functionally loaded. The patient was recommended not to clean the implant with a toothbrush for 7 days, but to rinse regularly.
Ten weeks after implantation, an alginate impression was made with the healing screw removed and a transfer coping in its place. The impression was forwarded to the laboratory together with the Orthodontic analog in order to fabricate the rigid attachment unit for insertion onto the implant. Until delivery of said attachment, the implant was closed again with the healing cap attached by the healing screw (Fig. 8). |
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Fig. 8. Incorporated ortho implant in the heasling period covered by healing cap |
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Laboratory procedure
The working model was prepared from the accurate alginate impression using (hard) dye stone. A steel coping was screwed on and laser-welded to a yoke from a 0,9 x 1,9 mm tempered steel to be attached to the lingual braces of the incisor and bicuspid in order to serve as a triangular-shaped anchorage unit (Fig.9).
Twelve weeks following implant placement, the attachment was incorporated by screwing in the steel coping. Minimal bending of the yoke allowed reaching the final position of the two lingual brackets. The direct connection with the incisor and bicuspid created an “anchorage triangle”. Loops were welded to the yoke to provide additional anchorage. Patient tolerance of the appliance was excellent. Supermaximal anchorage for movement of the ectopic canine was achieved.
Conclusions
The Ortho implant placed in the palate provides skeletal anchorage to align ectopic teeth. In concert with a lingual orthodontic appliance, a simple alternative to multi-attachment/bracketed appliances can be successfully utilized.
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Fig. 9. Anchorage triangle - Left: incorporated; Right: on plaster model |
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www.lingualnews.com
Adult and Lingual Orthodontics
EDITORS:
Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc
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