Segmental osteotomy for mobilization of dental implant

Abstract

Purpose: The aim of this work is to evaluate a surgical technique for mobilization of mal posed dental implant in anterior area.

Methods: A 38-year-old patient consulted our unit for esthetic dissatisfaction with the implant treatment of a central incisor. An implant was observed in 11 and 21, where 11 was 3 mm above the ideal limit, with excessive vestibular angulation. The choice was made to perform a segmental osteotomy and mobilize the bone block and the implant down and forward; a bone block extracted from the mandibular ramus was installed between the implant block and the bed to stabilize the segment.

Results: After 4 months, a conventional fixed prosthesis was created and the esthetic result achieved was close to what the patient wanted, with no need for further surgery. The surgical condition was stabilized and maintained for the long-time and no complications how necrosis, infection or bone defects was present.

Conclusions: It was concluded that the procedure is efficient, and the biological arguments in favor of the procedure are discussed.

Keywords: Dental implants; Osteotomy.

Figure 1

(A) Inadequate positioning of implant 11, 3 mm over the ideal cervical limit. (B) Anterior position of 11 in relation to the lateral incisor and adjacent implant.

Figure 2

Periapical radiograph of implants 11 and 21 free of pathology, peri-implantitis, or any other type of alteration.

Figure 3

Study of models and surgery on models to identify the planned movement needed for repositioning 3 mm downwards and 2 mm posterior.

Figure 4

Vestibular maxillary incision close to the bottom of the vestibule 3 cm long.

Figure 5

Horizontal and vertical osteotomy of the block with the implant. The osteotomy reaches the palatal periosteum. The superior vertical osteotomy is performed 5 mm over the apical limit of the implant recorded by another osteotomy guide.

Figure 6

Mobilized bone block, maintaining contact with the palatal periosteum. A bone graft is installed in the superior sector to ensure the mobility and stability of the 3 mm downward movement.

Figure 7

Autogenous particulate bone graft installed in the osteotomies and in the defects caused by mobilization of the bone block.

Figure 8

(A) Simple suture of the incision without excessive traction of the flap. (B) Implant 11 located posteriorly at its cervical level after rotating the apical sector vestibularly.

Figure 9

Metal ceramic fixed prosthesis installed on the implants, maintaining adequate esthetics and correct functionality. The regional esthetic can be optimized with manipulation of the soft tissue and dental management in a second operation.