J Dent Rehabil Appl Sci.  2019 Dec;35(4):244-252. 10.14368/jdras.2019.35.4.244.

Strategic surgical-combined orthodontic treatment planning of patient with missing incisors on maxilla: a case report

• Park JH
• Jeon J
• Zhao S
• Jeon YM
• Kim JG

• KMID: 2470630
• DOI: http://doi.org/10.14368/jdras.2019.35.4.244

Abstract

Proper positioning of maxillary incisors is key to success of surgery combined treatment. Establishing surgery plan would be a difficult job if maxillary incisors are lost. Patient who lost all of her maxillary incisors due to accident came for orthodontic treatment. Through careful modification of maxillary archform, pre-surgical orthodontic treatment was conducted with four prosthetic space consolidation. Position of incisors was decided by help of 3D prosthetic set-up, and 1-jaw surgery was planned. After relative short treatment period of 28 months, final prosthesis was done. When alveolar bone loss happens, harmonious prosthesis of upper incisors is difficult. Utilizing mandibular set-back surgery and incisor positioning using 3D set-up could make a better environment for treatment outcome. Strategic pre-surgical orthodontic treatment can allow shorter time and less number of prosthetics.

Keyword

incisor teeth loss; orthognathic surgery; pre-surgical orthodontic treatment

MeSH Terms

Alveolar Bone Loss
Humans
Incisor*
Maxilla*
Orthognathic Surgery
Prostheses and Implants
Treatment Outcome

Figure

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  Fig. 1 Radiographs of patient obtained at the time of trauma.

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  Fig. 2 Extraoral and intraoral photos of patient obtained before orthodontic treatment.

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  Fig. 3 Cephalometric and panoramic x-rays obtained before orthodontic treatment.

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  Fig. 4 Pre-surgical orthodontic treatment plan. (A) camouflage treatment with 6 prosthetics, (B) 4 prosthetics with modification of maxillary dentition.

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  Fig. 5 Pre-surgical orthodontic treatment progress. (A) Photographic image at 4 months, (B) Photographic image at 9 months, (C) Photographic image at 12 months.

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  Fig. 6 Extraoral and intraoral photos of patient obtained after 12 months of treatment (pre-surgical assessment).

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  Fig. 7 Model surgery progress. (A) Incisor positioning with 3D program, (B) Paper surgery with positioned incisors, (C) Final occlusion for surgical wafer.

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  Fig. 8 Post-surgical orthodontic treatment progress. (A) 4 weeks after surgery, (B) 7 months after surgery, (C) Appliance removal with provisional restoration.

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  Fig. 9 Extraoral and intraoral photos, radiograph data obtained after final prosthesis.

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  Fig. 10 Superimposition of pre-treatment and treatment result. Red line: pre-treatment, Green line: post-treatment.

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  Fig. 11 X-ray superimposition. White line: at-trauma, Yellow line: after 2-years. Resorption of maxillary alveolar bone (Red box) is prominent (Red arrow).

Reference

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