Orthotown April 2021 - 28

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dhmjdds
Member Since: 11/16/04
Post: 15 of 18

Thank you very much, Vaughn! Wonderful to hear from a true expert. What you said is quite
similar to what my daughter said, about molding the tissue with the provisional(s) and changing
the emergence profile, etc.
I am meeting with the GP this Friday to get his thoughts. Hopefully he is open to referring
to a prosthodontist for their input. We do have a dental school fairly nearby, so if there isn't a
private practice prosthodontist that works, I'll send her to the prosth department there. If that's
a good idea?
I'm a bit concerned about doing the ortho with the implant there, though. I feel like in order
to open enough space in the lower arch for full alignment (non-extraction), that I will need to
move the lower incisors forward significantly. And in order to do that, I need to flare the upper
incisors-so where does that leave the implant? ■
7/27/2020

wvholland
Member Since: 07/25/09
Post: 16 of 18

Prosth program works, they should certainly know how to manage the emergence profile if
they have a good implant program.
I think she is basically a Class I deep bite. The LLE gives you a tooth size discrepancy but
it is ankylosed so it isn't really expressing that size discrepancy (also she is perfect Class I on the
left). She is Class I canine on the left, Class II in the right. I think a little IPR OB the lower and
you should be fine with treating her as-is.
The implant positioning is something to consider, though. I doubt it is palatal enough to be
an issue; I think leveling the lower arch and manipulating the emergence profile of her implant
are the keys to her treatment. Obviously, you can consider more complicated options, and it
may be that the implant is just positioned wrong, but I would definitely have her work with the
provisional on #7 first before doing anything more complicated like taking out teeth! ■
7/29/2020

tom525
Member Since: 06/18/08
Post: 17 of 18

It would be a great service for their patients if they were referred for orthodontic consult
before the implants were placed. I have recently had two patients need to get their new implants
removed before starting their treatment. #7 implant and K extractions would be a treatment plan
that would allow you to correct her subdivision malocclusion. I'd prefer aligners for this young
lady so the Pontic space can be filled. #7 soft tissue and bone level look favorable. CBT and ceph
would be helpful. Working with experienced specialists in this case would be prudent. Thank
you for sharing your patient's case. ■
3/7/2021

orthodds90
Member Since: 06/25/13
Post: 18 of 18

I'm in agreement with tom525. Too many times the primary care/general DDS thinks only
about today's production and too little about what's in the general welfare of the patient. So, this
kind of single-tooth implant and crown gets down without even considering the other alignment
and occlusal issues throughout the mouth. Then when the patient isn't totally pleased, the options
become possibly limited by the very presence of the recently done implant!
However, there are multiple good defendable options by more knowledgeable folks than me (above)
that should be given serious consideration (of course, in thorough consultation with the patient).
I see this as an opportunity for all of us to do a better job of educating our primary care
colleagues about interdisciplinary care. ■
3/8/2021

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Orthotown April 2021

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