ortho - the international C.E. magazine of orthodontics

ortho1_201320 I I clinical_ esthetics incisor is higher than the right central incisor, the situation is complicated. When the gingival margin is at the same level, it is less complicated. However, when it is even lower, the problematic situation of losing soft tissue might not be entirely solved, but it is a much more favorable situation. In this case, the extraction of the tooth was ex- pected from the very beginning, so why not use it before its extraction by bringing the soft tissue to a better position by using different orthodontic forces and vectors and facilitate the work of the rest of the multidisciplinary team? Depending on the type of extrusion, soft or hard tissue can be extruded. The boundaries of hard and soft tissue extrusion are not clear in the literature. Yet, what is clear is that soft tissue will come down with an extrusion. In the case shown here, the new soft tissue formed after the orthodontic extrusion will help the outcome. In the next peripheral radiographs (Fig. 4), the ex- trusion of the left central incisor is shown as a visual reference of the orthodontic extrusion, so the excess of gutta-percha can be used. A 4 mm displacement of the root was created, which was the amount of gingival margin needed for the prosthodontics to work (Fig. 5). At this point, the gingival margin of the leftcentralincisorisevenlowerthantherightcentral incisor. The amount of hard tissue extrusion in this case was almost imperceptible. Inthesetypesofcases,anexcessofsofttissuewill facilitate the implant surgery (Fig. 6). Even though new soft tissue is formed orthodontically (vertical dimension), every time an implant is placed in the anterior zone, a soft-tissue graft is performed at the timeofthesurgeryatthebuccalzone.Thisishowthe prosthodontistwillreproducethevolumeofsofttis- sueintheareaoftheimplant(Figs.7,8).Thiswillhelp avoid future translucency of the implant. Once the braces are placed, the orthodontist can solvethesmallrotationstoachieveabettersituation in the anterior zone. During the healing period (Fig. 9), no orthodontic movements must be done. It is of great importance thatduringthisperiod,thetemporariesperfectlyseal thesofttissue.Acomfortabletemporaryisfabricated to use during orthodontic treatment. Because of the round wire used at this point in the treatment, we use a stainless-steel ligature to fix the brackets and avoidanyorthodonticmovement.Thetemporarywill seal and protect the soft tissue of the compromised area (Fig. 10). Twomonthsaftersurgery,thesofttissuepresents healthy and the soft tissue at the compromised area is below the level of the gingival margin of the right central incisor. _Case report: Part II Orthodontic treatment in this multidisciplinary case was used not only to align the teeth but also to extrude the left central incisor (which was going to be extracted from the beginning) in order to create a more favorable situation for the rest of the special- ists. Thetreatmentplanoptionforthiscasewassetup before starting the orthodontic treatment. A tooth replacement was planned for the left central incisor, andaveneerwasplannedfortherightcentralincisor to achieve a great esthetic result. Knowledge of the treatment plan before begin- ning will allow the orthodontist to help improve future restorative procedures. Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 8