Pacific Coast Society of Orthodontists Bulletin Fall 2022 - 48

Clinical Practice
Earl's Pearls
Retaining Missing Lateral Space for
Future Implants?
I was privileged to be a partner in practice with Earl Johnson. His passion for efficient and comfortable
biomechanics bore so many wonderful pearls. This one solved the important problem of preventing the
roots from migrating into the lateral space while waiting for the patient to stop growing, so the implant
can be placed.
-Dr. Jerry Nelson
Dr. Earl Johnson
Most orthodontists have had the experience of completing
orthodontic treatment on a 13 to 15-year-old
patient who is missing a lateral incisor. The roots have
been perfectly placed parallel with adequate space
to allow room for the future implant and final crown.
However, surgical placement of the implant must wait
until alveolar growth has stopped (ages 18-21). Usually,
during this interim, the patient wears a retainer
with a pontic (Fig. 2). This provides good esthetics but
often does not provide excellent root control.
Figure 1. Finished case with a missing lateral incisor
Unfortunately, during this retention period, the roots
adjacent to the implant site often gradually migrate
(tip) into the intended implant site. If this happens,
you now must involve the patient in another period
of orthodontic treatment, repositioning the aberrant
roots before the implant can be placed.
An esthetic alternative to the flipper might be a bonded
Maryland bridge. However, they need some tooth reduction
and come loose 25% of the time, both of which
can be a disadvantage to the dentist and patient.
The teeth adjacent to the implant site can be held
more effectively by using two retaining devices. The
normal esthetic pontic-bearing retainer can be used
during the day while a second slip cover retainer
can be used at night (Fig. 3). Since the slip cover
retainer does not have a pontic, it can hold the entire
crown of the neighboring teeth much more securely.
Securely held crowns resist root movement more
effectively while waiting for the implants to be placed.
An additional advantage of the two-retainer approach is
when, Heaven forbid, the plastic pontic is broken off the
retainer. The slip cover retainer will hold things while a
new replacement pontic-bearing retainer is made.
This clinical pearl is reprinted from an original article
published previously by Dr. Earl Johnson in the Bulletin.
Figure 3. Night-time slip cover retainer for good space
and root control
Figure 2. Retainer with a plastic pontic maintaining
future implant space
48
PCSO Bulletin Fall 2022

Pacific Coast Society of Orthodontists Bulletin Fall 2022

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2022

Pacific Coast Society of Orthodontists Bulletin Fall 2022 - 1
Pacific Coast Society of Orthodontists Bulletin Fall 2022 - 2
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Pacific Coast Society of Orthodontists Bulletin Fall 2022 - 48
Pacific Coast Society of Orthodontists Bulletin Fall 2022 - 49
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Pacific Coast Society of Orthodontists Bulletin Fall 2022 - 64
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