Dental Tribune U.S. Edition

Clinical DENTAL TRIBUNE | September 201112A AD case, she would have been com- promised because of the amount of soft tissue visible. The patient stated that she had been presented with options such as soft-tissue grafts post implant placement; reposition- ing the muscle attachments to mini- mize lip movement, thus exposing less soft tissue when smiling; and even an orthognathic procedure that would truly be the only way to pre- dictable solve her esthetic dilemma. The only procedure (Laforte) that would provide our patient with an ideal solution was very expensive, invasive and had its own potential set of postoperative problems. As a result, the patient was content to do nothing because the only pre- dictable option was financially out of reach: the functional restorative plan was itself a financial burden, not to mention the thought of yet another lengthy phase on top of what she had already been through. Sometimes the “K.I.S.S. Theory” (keep it simple, stupid) is the best. If we could find a non-surgical, inex- pensive and reversible procedure that could at least improve on some of her esthetic challenges, she would be receptive. We took impressions and sent them to the lab to produce an insert (bumper) that has the ability to blend in with the underlying soft tis- sue and make the junction invisible (Fig. 16). After placing the insert and adding some texture, the margins disappeared (Fig. 17). Although the lip still shows too much soft tissue, the teeth are now symmetrical (Fig. 18). Summary The use of the 2.2 mm ERA implant and orthodontics as tools to aid in bone augmentation — even though they are not thought of as conven- tional tools for this — proved to be very effective. I believe we will see more situa- tions where they will be thought of as a treatment of choice to produce more predictable results. DT References 1. Bell WH: Immediate surgical repositioning of one and two dento-osseous segments. Int J Oral Surg 2:265–272, 1973. 2. Bell WH, McBride K: Surgical prosthetic rehabilitation of adult dentofacial deformities. In Bell f DT page 9A active controlled orthodontic was reinstated. Treatment phase No. 3 After four months of orthodontic intervention to create an ideal func- tional occlussal scheme and osteoge- nisis in the anterior region (Fig. 9), we removed our ERA implants using a 2.4 trephine bur that was ideal for placing our 3.3 mm implant in the lateral area and 3.75 mm implant in the central incisor area. We gained the necessary verti- cal height in bone via our com- bined surgery and small amount of orthodontic osseous distraction, but were still deficient facially, which we achieved by expanding the ridge with the implant in the undersized osteotomy along with bone augmen- tation utilizing an autogenous block graft harvested from the mandible (Figs. 10–12). It took another five months to finalize the orthodontic treatment, at which time the abutments were placed and the ideal soft-tissue symmetry and emergence profile was refined with the anatomically shaped resin transitional crowns (Figs. 13, 14). In conclusion, while the total treatment was 15 months, utiliz- ing orthodontics to correct not only occlussal disharmony but also help create hard-tissue support for the implants, soft-tissue symmetry was actually the conservative treatment option. I believe that orthodontics will play a much larger role in provid- ing new bone for cases requiring implant support. Case No. 2 In the second case, the patient pre- sented with no complaints, having recently completed the restorative phase of her full-mouth rehabili- tation. It was noted that she had an extremely short upper lip that revealed a very toothy smile. The maxillary incisors were supported with four individual implants and her final restorative result was func- tionally sound. The esthetic result was compro- mised by extremely long incisors due to the loss of soft tissue (Fig. 15). Even if that had not been the Fig. 15: A short upper lip and loss of soft tis- sue created a significant esthetic challenge.