Dental Tribune Middle East & Africa Edition

DENTALTRIBUNE Middle East & Africa Edition Media CME 7 by expanding the ridge with the implant in the undersized os- teotomy along with bone aug- men- tation utilizing an autoge- nous block graft harvested from the mandible (Figs. 10–12). It took another five months to finalize the orthodontic treat- ment, at which time the abut- ments were placed and the ideal soft-tissue symmetry and emer- gence profile was refined with the anatomically shaped resin transitionalcrowns(Figs.13,14). In conclusion, while the total treatment was 15 months, uti- liz- ing orthodontics to correct not only occlussal disharmony but also help create hard-tissue support for the implants, soft-tis- sue 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 Inthesecondcase,thepatient 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 com- pro- mised by extremely long in- cisors due to the loss of soft tissue (Fig.15).Evenifthathadnotbeen the 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 expos- ing less soft tissue when smiling; and even an orthognathic proce- dure that would truly be the only way to pre- dictable solve her es- thetic 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 postopera- tive problems. Asaresult,thepa- tient was content to do nothing because the only pre- dictable option was financially out of reach: the functional restorative plan was itself a financial bur- den, 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. The- ory”(keepitsimple,stupid)isthe best.Ifwecouldfindanon-surgi- cal, inex- pensive and reversible procedure that could at least im- prove on some of her esthetic challenges, she would be recep- tive. Wetookimpressionsandsent them to the lab to produce an in- sert (bumper) that has the ability to blend in with the underlying soft tis- sue and make the junc- tioninvisible(Fig.16).Afterplac- ing the insert and adding some texture, the margins disap- peared (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 toolstoaidinboneaugmentation — even though they are not thoughtofasconven-tionaltools for this — proved to be very ef- fective. I believe we will see more situa- tions where they will be thought of as a treatment of choice to produce more pre- dictable results. 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 W, Proffitt, Whit (eds): Surgi- cal Corrections of Dentofacial De- formities, Vol. 2. Philadel- phia, WB Saunders, 1980, pp. 1570–1582. 3. Burk JL, Provencher RF, Mc- Kean TW: Small segmental and unitooth osteotomies to correct dento-alveolar deformities. J Oral Surg 35:453, 1977. 4. Carrick J, Storum K: The dental component of facial esthetics. AACD J 52:52–61, 1997. 5. Merrill RG, Pedersen GW: Inter- dental osteotomy for immediate repositioning for dental-osseos elements. J Oral Surg 34:118, 1976. 6. Schgallhorn R: The use of au- tognous hip marrow biopsy im- plants for bony crater defects. J Peridont 39:145, 1968. Fig. 10: Arrows show osteotomy sites utilizing 2.4 mm triphine bur to remove ERA implants. Narrow ridge regained height but not width. Fig. 13: Six-months post-implant placement. Two-weeks post second-stage abutment and temporization. Fig. 12 Fig. 11: a) Donor site; b) size and shape graft and c) block graft). c a b Fig. 14: After shows post ERA implant dis- traction post. Primary implant placement inte- gration and final tem- porization before final prosthesis. After Before Fig. 16a Fig. 16b Fig. 17: A simple solution for a complex problem. Fig. 18 After Before Fig. 15: A short upper lip and loss of soft tis- sue created a significant esthetic challenge.