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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 10  |  Issue : 1  |  Page : 44-46

Intrusion of an overerupted maxillary molar with orthodontic mini implants for implant restorative purposes


1 Postgraduate Implant Department, Universidad San Sebastian, Santiago, Chile
2 Postgraduate Implant Department, Santiago, Chile

Date of Web Publication26-Feb-2018

Correspondence Address:
Dr. Gilberto Salazar
Tomas Moro 1806, Las Condes, Santiago
Chile
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_236_17

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  Abstract 

This case report presents the use of orthodontic micro screw implants to intrude an overerupted maxillary first molar as a strategy to obtain adequate interocclusal space for replacing a missing first lower opposing molar. A 37-year-old female who have recently finished her orthodontic treatment and a mandibular first molar missing was treated for the tooth replacement and successful intrusion of the opposing molar using two orthodontic micro screw implants previous to the final restoration. This is a conservative approach to avoid this kind of situations that can complicate the prosthetic treatment.

Keywords: Edentulous space discrepancy, molar intrusion, orthodontic microimplants


How to cite this article:
Salazar G, Serrano AF, Mazzey GO. Intrusion of an overerupted maxillary molar with orthodontic mini implants for implant restorative purposes. J Int Oral Health 2018;10:44-6

How to cite this URL:
Salazar G, Serrano AF, Mazzey GO. Intrusion of an overerupted maxillary molar with orthodontic mini implants for implant restorative purposes. J Int Oral Health [serial online] 2018 [cited 2018 Sep 25];10:44-6. Available from: http://www.jioh.org/text.asp?2018/10/1/44/226180


  Introduction Top


Overeruption and subsequently decrease of bone support of molars in patients who have lost the opposing molars is frequently observed.[1] This situation can complicate the situation for the restorative procedures to replace the missing molar after an implant placement because the interocclusal free space would be reduced by the antagonist tooth movement.[2],[3]

Molar intrusion is one of the most difficult movements in orthodontics, and several techniques have been described.[4],[5],[6],[7] Since microimplants were introduced to the therapy, these devices are the most conservative alternative to normalize the occlusal plane when teeth have migrated because by restorative approaches, endodontic treatment, post, and a crown should be needed to reduce the crown size of the overerupted molar or in extreme cases, an extraction is the option.

The following case presents an adult patient that received an orthodontic intrusion of an upper first molar using orthodontic microimplant with the aim to create appropriate interocclusal space for a first lower molar crown over an implant.


  Case Report Top


A 37-year-old female patient who has recently finished an orthodontic treatment and was referred to the postgraduate implant program at San Sebastian University for a tooth replacement (tooth # 4.6) with an osseointegrated implant. The clinical situation shows that the tooth 1.6 was overerupted and consequently reducing the occlusal space for the future crown [Figure 1] and [Figure 2]. Diagnostic wax-up and radiographical and surgical guide were performed previously to the implant placement surgery (Tooth 4.6). Implant was placed and immediately provisionalized with an acrylic screwed crown. At the same surgical time, 9 mm orthodontic micro screws (Neodent®, Brazil) were placed buccal apical and palatal to tooth 1.6 and tensed by chin elastic 150 g [Figure 3]. The chain was changed each 2 weeks. After 7 months, the upper molar was intruded and aligned in the occlusal plane, after that was retained for 3 months [Figure 4]. After 10 months, a zirconia screwed crown over a CrCo abutment was performed [Figure 5] and [Figure 6].
Figure 1: Incisal case tooth 1.6 overerupted and lingualized

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Figure 2: Incisal case tooth 1.6 overerupted and lingualized

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Figure 3: Two weeks after the implant placement in tooth 4.6, micro screws were inserted and started the intrusion treatment

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Figure 4: Nine months after, a zirconia crown was screwed on implant (tooth 4.6). Not only the vertical but the bucco-lingual position in the arch of tooth 1.6 was corrected

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Figure 5: Nine months after, a zirconia crown was screwed on implant (tooth 4.6). Not only the vertical but the bucco-lingual position in the arch of tooth 1.6 was corrected

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Figure 6: Nine months after, a zirconia crown was screwed on implant (tooth 4.6). Not only the vertical but the bucco-lingual position in the arch of tooth 1.6 was corrected

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Planning

Photographic registration, semi-adjustable model articulation, diagnostic wax-up, periapical X-rays, and a radiographic guide that were used for the computed tomography scan imaging, previous to the surgical procedure.

Implant insertion

Local asepsis with iodine-povidone for the perioral skin, Chlorhexidine 2% rinsing for 2 min, and local infiltrative anesthesia (2% lidocaine with epinephrine) was used in the 4.5-4.6-4.7 zone and in 1.6 buccal and palatal. After a full-thickness flap, a 4.1 mm × 10 mm IS II Active implant (Neobiotech®, Korea) was inserted at 4.6 zone, initial torque was 40 Ncm2, and an immediate screwed acrylic provisional was placed without any occlusal contact. Neodent 2.5 mm × 9 mm orthodontic micro screws were placed flapless apical to the root tips of tooth 1.6, orthodontic buttons were adhered with orthodontic composite to the buccal and palatal faces of tooth 1.6, a 150 g elastic coil was connected to the buttons and the micro screws heads. Patient was instructed to change the elastic coil each 2 weeks. Monthly clinical and radiographic controls were performed to check the implant osseointegration and the intrusion advances. After 7 months, the molar 1.6 intrusion was achieved; it was retained for three additional months. After 10 months, a zirconia (BruxZir) crown was performed over a CrCo UCLA abutment, sealed with Teflon tape and composite brilliant.


  Discussion Top


This case presents a multidisciplinary approach to treat a common problem as molar extrusion when restoring with dental implants in the molar region. Intrusion and tipping of molars previous to a restorative treatment of edentulous spaces is a conservative alternative therapy for patients which in other conditions would be subjected to restorative procedures to correct the tooth position and to increase the interocclusal space. There are some limitations as the restorative treatment time is increased and some patients may reject this alternative because is time consuming and their final restorations will be delayed, even though if the pros and cons are clearly explained before there will be no reason for them to refuse because usually after 12 weeks they can bite with their provisionals.

There are no systematic reviews about this topic; the only references are limited to case reports. In this case, a 150 g force and two micro screws showed to be effective to perform a 3 mm buccal and 4 mm lingual controlling torque and molar inclination. Even though in more overerupted cases, two buccal micro screws placed mesial and distal to the molar could help to give more anchorage and have a better intrusion. The retaining time could be shortened if the crown of the opposing tooth is performed at the intrusion achievement time, so relapse is a rare phenomenon in this kind of cases.

There were no periodontal pockets observed in this case and vitality was positive after the treatment was completed, so tissue and dental health were preserved.

This type of treatment should raise the controversies that is difficult to control the uniform intrusion of the molars and that it will be more difficult to intrude lower molars due to the lower jaw bone density.

Further clinical studies should be developed to evaluate and standardize clinical techniques, times for treatments, also to evaluate tooth vitality, periodontal changes, and complications during and after the treatment.


  Conclusion Top


Molar intrusion using orthodontic micro screws is a conservative, predictable, cheap, and simple procedure that is well-tolerated by patients. This case shows an adequate leveling of an upper molar before a final implant restoration on the opposing tooth. The patient did not show a relapse or adverse effects on the pulp or tissues.[8],[9]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lindskog-Stokland B, Hansen K, Tomasi C, Hakeberg M, Wennström JL. Changes in molar position associated with missing opposed and/or adjacent tooth: A 12-year study in women. J Oral Rehabil 2012;39:136-43.  Back to cited text no. 1
    
2.
Craddock HL, Youngson CC, Manogue M. Deviation from the broadrick occlusal curve following posterior tooth loss. J Oral Rehabil 2006;33:423-9.  Back to cited text no. 2
[PUBMED]    
3.
Craddock HL, Youngson CC, Manogue M, Blance A. Occlusal changes following posterior tooth loss in adults. Part 1: A study of clinical parameters associated with the extent and type of supraeruption in unopposed posterior teeth. J Prosthodont 2007;16:485-94.  Back to cited text no. 3
    
4.
Craddock HL, Youngson CC. A study of the incidence of overeruption and occlusal interferences in unopposed posterior teeth. Br Dent J 2004;196:341-8.  Back to cited text no. 4
    
5.
Craddock HL, Youngson CC. Overeruption in unopposed posterior teeth. Br Dent J 2004;196:337.  Back to cited text no. 5
    
6.
Hakami Z. Molar intrusion techniques in orthodontics: A review. J Int Oral Health 2016;8:302-6.  Back to cited text no. 6
  [Full text]  
7.
Sabuncuoglu FA, Ersahan S. Changes in maxillary molar pulp blood flow during orthodontic intrusion. Aust Orthod J 2014;30:152-60.  Back to cited text no. 7
    
8.
Ng J, Major PW, Flores-Mir C. True molar intrusion attained during orthodontic treatment: A systematic review. Am J Orthod Dentofacial Orthop 2006;130:709-14.  Back to cited text no. 8
    
9.
Bayani S, Heravi F, Radvar M, Anbiaee N, Madani AS. Periodontal changes following molar intrusion with miniscrews. Dent Res J (Isfahan) 2015;12:379-85.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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