"A case of applied implant along with orthodontics for treatment"

In the past years, it is been notable the patient's demand for dental examination and treatment

In our clinic, from the day of its establishment on, i have tried to get improved the level of Orthodontics and implant examination and treatment.

However, regarding actual examination and treatment, there are cases where we encounter some restrictions due to the patient's economic situation, treatment's required time, etc.

Now, we present a report regarding cases given in our clinic over the past 3 years including interruption periods where at last instance our patients were able to complete their treatment almost as planned.

I would appreciate any opinion or criticism from our fellow doctors.

　As for orthodontic examination and treatment, it is Doctor Fujisaki who graduated from the same class as me (established in Komagome, Tokyo) who is in charge for this clinic.

Patient is a woman born in 1948
First examination ： March 25th 1996
Main complaint： Upper right molars removed
Anamnesis： None
Existing teeth： 754321 | 123456
7654321 | 123456

As symptoms, we have that the upper right bridge 7 6 5  is in a decaying state and upper right 5 is in a state impossible to save.

Also lower left 6 has being reduced to the root, lower left 7 is missing. At the time of the examination the occlusion was supported by 9.

　Since the patient refused to have the missing teeth replaced by a false tooth, i wanted to somehow dispose of a fixed restoration method.

The number of implants that the patient could afford was 2.

The only procedure available under these circumstances was extracting upper right 5 and implant a prosthesis at the upper right 56 part.

After the endodoncy, upper right 7 and upper right 4 were restored with a single crown.

Restoration procedure was applied only to the right side. I was unable to proceed the same way with the left side so i was limited to only extracting lower left 6.

After the tooth extraction , the primary treatment finishes. September 1996 Part 65. An ITI implant was inserted.

It is a total of 2 fixtures φ4.1mm, 12mm length φ4.1mm,
Upper right 7 and upper right 4 had attached a single crown each during the implant treatment period.

n March 1997, the installation of the upper part of the implant structure was tentatively complete.

Treatment at the secondary stage.
The patient had been received periodical examination, but the patient suddenly comes to the hospital

Argument of the patient for the visit： "I became able to afford the medical expenses, so I want to take the full treatment"

I heard how the patient explained about having become able to afford the medical expenses as her husband seemed to be worried about her upper jaw front teeth.

Upper right 1 of the upper jaw was being projected against the lip inner side. I was thinking about cutting the prosthesis but i received patient`s approval to correct the tooth alignment orthodontically.
 

In addition, I performed along the treatment to the upper and lower molars on the left side which i had not done last time.

In November 1997, we started with the orthodontic treatment.
In July 1998, The orthodontic treatment was almost complete. We started then with the Baoding treatment..

　During orthodontic treatment, the condition of the periodontal components surrounding the upper jaw front teeth enworsed. It was not able to remove the Baoding device. The upper jaw front teeth developed pockets around them considerably deep. These were pockets more than 7mm long, so i had to remove them surgically.

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On the same month, upper jaw 3-3 parts F-Ope.
In September 1998, an ITI implant was inserted into the the upper left 67th part.
φ 4.1mm, 12mm length 1 piece
φ 4.8mm, 10mm length 1piece
In october 1998, an ITI implant was inserted into the lower left 67th part .

φ 4.1mm, length 12mm 2 pieces in total

In June 1999, lower left 6 7 part had the superstructure attached .
In July 1999, upper left 6 7 part had the superstructure attached.
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The oral cavity condition finally improved as stated by the following dental formula below.
７６５４３２１|１２３４５６７
７６５４３２１|１２３４５６７

At the end, the patient seemed to be really satisfied.
Her husband seemed to be satisfied as well.

Also, occlusion support originally reported as 9 at the beginning of the treatment, improved to 14
At the present time, It is working fine without so much problem.

As results/ conclusions regarding the treatment of this patient,

　1. Depending on the application method of an implant, it is possible to keep the right vertical occlusion of the molars and also to prevent tooth misalignment and flare-up of the upper jaw.

　2. Thanks to the success of the orthodontic treatment, dental cuts and extractions were minimal and we had the patient aesthetically satisfied.

This time, we split the examination and treatment into 2 parts to make them match patient's convenience but regardless of that as for the patient and as well as for our clinic everything went fine without so many difficultie　It has served well as a incentive of confidence and as result itself without forcing in anyway the medical treatme Japanese Society of Oral Implantology 32th Annual Convention
"One case where onlay graft and sinus lift were applied to an aesthetic site simultaneously."

Slide1
Recently, implants became important as an option for deficient prosthesis cases.　

Treatment ｔｅｃｈｎｉｑｕｅs and materials have been accomplished a rapid progress every year, and now it is possible to treat cases that were usually difficult to treat in the past.

This time, We applied a treatment based on onlay graft and sinus lift to a case of accelerated bone resorption in front teeth.
We report as following the results of applying implant prosthesis with the objective of achieving an aesthetic improvement.

Slide 2
The patient is a 36 years old woman. She requests to have installed a tooth where it is missing.

The left slide is a picture of the inner oral cavity at the time of the first examination. The right slide is an X-ray picture.

The patient suffered a loss in the upper jaw front teeth during a traffic accident. This was fixed at the time with a metal bond bridge but the bridge broke apart and that's why we have now her visiting our hospital.

At the time of the first examination, we found absorption of an alveolar bone at high degree at the upper jaw front teeth part.

On January 27th 2000, we extracted the upper left 123 and an upper right 1 in a C4 state. The upper left 2 was in a impacted state.

Upper left 3 was adhered to the bone. Due to the several extractions , the alveolar bone absorption of the front teeth enworsed. We previewed considerable difficulties in the aesthetic prosthesis restoration.

Slide 3
Slide is an X-ray or CT photograph taken after the dental extraction.

in order to perform the implanting, it is absolutely necessary to improve the condition of the alveolar bone where the implant is to be inserted by any means.

We constructed 2 superstructures, a perpendicular one and the other one for being attached on both sides of the bone by applying ｏｎｌａｙ ｇｒａｆｔ and sinus lift. With this we were ready to insert the implant.

Slide4 

On May 24th 2000, we presented this case to Meikai University Department of Oral Surgery 1st course. On October 30th of the same year, ｏｎｌａｙ ｇｒａｆｔ and sinus lift were applied simultaneously. Right and left slides show the observationts taken during the operation .

The bone was extracted from the mentalis muscle. I performed the ｏｎｌａｙ ｇｒａｆｔ using a block-shaped bone and mainly spongy bone for sinus lift.

Slide5 
The spongy bone which I was able to extract was about 4.5CC. This was used along with BONE JECT 2CC. The prognosis was good. The left slide shows observations taken during the operation. The right slide is a photograph taken inside the mouth to establish a comparison before and after the bone creation.

Slide6 
The left slide is a photograph from inside the oral cavity at five months of postoperation, The right slide is an X-ray photograph.

Slide7 
The left slide is a CT photograph taken at this time, it shows an improvement of the upper jaw alveolar bone.

As seen on the right slide, In December 2001, the implant was inserted. An ITI implant into upper left 3 and upper right 23.

A φ 3.3mm, 12mm length was inserted. Insertion into the upper left 2 was abandoned as the palatal side was healing and the bone was in bad conditions. φ3.3ｍｍ。。
The right side of the right slide is an impression picture taken from inside the mouth in December 2001.

Slide8 
A side-screw-removable-type metal bond bridge served as superstructure for the upper left and upper right 23 part.

Right and left slides are pictures taken from inside the mouth at the time the last prosthesis was attached.

Slide9 

X-ray picture
This slide is an X-ray dental photograph taken at the time the last prosthesis was attached.

The alveolar bone superstructure (GBR method) the perpendicular one and the one applied on the 2 sides, both happened to be satisfactory. Upper right 32 and upper left 3 could be implant-inserted.　The superstructure is a side-screw-removable-type bridge but also resulted aesthetically satisfactory .

Conclusion
We applied  onlay graft and sinus lift for achieving an aesthetic improvement in a case of high bone resorption.
Compared to the traditional method, this implant treatment had more satisfactory results and presented less difficulties.

On the other hand, I had a really hard time when transplanting the bone. I expect a prompt progress regarding donation and development of materials.