Orthotown April 2021 - 26

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danbraces
Member Since: 11/09/08
Post: 8 of 18

Time and money solve quite a few problems. Maybe remove, consider a porcelain bonded
bridge or temporary Pontic with bone graft and eventual replacement after positioning the anterior
teeth for cosmetics and function. ■
7/14/2020

justinudm
Member Since: 09/29/14
Post: 9 of 18

This is the dreaded implant in a VME patient. I would agree that sending this to a good
periodontist and prosthodontist is the starting point.
It looks like the clinical crown of the implant is shorter and therefore there is a noticeable
difference in the gingival show of #7 compared to #10. This would likely require taking the implant
out. Grafting for more labial bone and placing a bone-level implant to improve the emergence
profile of the crown. It's a tough situation to solve. ■
7/19/2020

dhmjdds
Member Since: 11/16/04
Post: 12 of 18

Thanks for all of the comments!
Interesting thought, ext'g the lateral, removing the implant and resolving the lower crowding
with exts as well. This is definitely a plan I will present to her.
My periodontist has asked to have a consultation with her, to evaluate the implant and gingiva,
so we'll be getting that set up. But first I will be meeting with the GP to get his thoughts on
the situation. Then probably a consult with prosth will be needed also. We don't have a lot of
prosthodontists in this area.
My daughter, who lives in Pittsburgh, looked at the records as well. She did an implant
fellowship and does a lot of implant work. She knew immediately from the appearance that a
GP had placed the implant and crown.
She feels that the implant will need to be removed in any case but recommended a consult
with a relatively young prosthodontist who does a lot of implants; maybe they would be able to
improve the appearance of the current situation if she cannot/will not have the implant removed.
I'll try to keep everyone posted on the progress of the case. ■
7/23/2020

NY sent
Member Since: 10/10/05
Post: 13 of 18

We just came up with the same treatment plan on a similarly aged patient who has a giant
geminated UR2-exo upper 2s, lower 4s. Definitely out of the box, but I think teaming with a
good prosthodontist for restorations afterwards will give her a great improvement. ■
7/24/2020

wvholland
Member Since: 07/25/09
Post: 14 of 18

Diane, let me start this thread by saying I did a dual prosthodontics and orthodontics residency.
I only practice ortho now but I see a ton of interdisciplinary cases because I still enjoy them.
It sounds to me like the problem is the implant. We all see the other stuff, but she sees the
implant. I would recommend discussing this with a good general dentist if you don't have a
prosthodontics in the area.
Before you have a perio take out the implant and graft, you should first see if the crown contours
can be changed to solve the problem. This is the most predictable and the least expensive option
for her and is very likely to work. Adding a more convex facial gingival contour to the implant
(in the provisional stage) is how you manipulate the gingival margin to its desired location.
This also requires goon implant positioning, but often you can mask a poorly placed implant
with a well-contoured provisional. In my opinion, this is the first step.
If she wants orthodontic treatment too, then do it with this new provisional in place. She is a
Class I deep bite. My opinion: Don't make it complicated. I really don't think taking out teeth is
the answer on this girl; this is straightforward orthodontics if the implant itself is fine. I say take
it one step at a time, starting with a new provisional on #7. Hope this helps. ■

7/25/2020

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