A piezo surgery with corticotomies and implant placement as part of a multidisciplinary approach to treat malocclusion disorder in an adult patient: clinical report

Abstract

This clinical report illustrates a multidisciplinary approach for the rehabilitation of a young adult patient affected by a bilateral edentulous space and an anterior deep bite. The patient required orthodontics and surgical corticotomy and implantology (both performed with a piezo device). A multidisciplinary planning approach, including orthodontics, oral and periodontic surgery, and restorative dentistry, has an important role in the final outcome of treatment. In fact a dental class I occlusion has been established only on the right side. The left side could not be restored to an ideal class I relationship due to the pontic prosthesis. The original collapsed right posterior occlusion was corrected. A stable posterior occlusion was established, and the balancing interference was eliminated. Centric relation and centric occlusion were established at the same vertical dimension of occlusion. The cephalometric analysis and clinical aspect at the end of treatment showed that the patient had improvements in overbite and overjet.Multidisciplinary management, including endodontic and restorative dentistry, periodontics, corticotomy-assisted orthodontics, implants, and prosthetics, was used for a young female patient with multiple missing teeth, anterior deep bite, and a malocclusion with cant of the occlusal plane. The interaction of interdisciplinary specialties and careful treatment planning were required. The patient also benefited esthetically from our effort.

Keywords: Corticotomies; Multidisciplinary approach; Oral implantology; Piezo device.

Fig. 1

Initial frontal intraoral aspect

Fig. 2

Initial lateral intraoral aspect

Fig. 3

Some metal ceramic crowns in the upper left maxillary arch with a very poor esthetic appearance

Fig. 4

The panoramic radiography and cephalometric analysis revealed a partially edentulous mandible

Fig. 5

The panoramic radiography and cephalometric analysis revealed a partially edentulous mandible

Fig. 6

Orthodontic bracket placement: frontal view

Fig. 7

Ortodontic bracket placement: right side view

Fig. 8

Orthodontic bracket placement: left side view

Fig. 9

A microsurgical corticotomy was mandatory to assist orthodontic tipping and intrusion of elements 16 and 17

Fig. 10

A triangular-shaped corticotomy was performed with inserts OT7 0.55 mm and OT7 special 0.35 mm to accelerate orthodontic tooth movements

Fig. 11

A mesiobuccal root surface exposure of element 16 required bone regeneration through Bio Oss and bone chip application

Fig. 12

The total width flap was sutured

Fig. 13

Implant site preparation: OP5, IM2, OT4, and IM3 (correctly in sequence)

Fig. 14

Implants placement after site preparation

Fig. 15

All implants received immediate healing screws

Fig. 16

After orthodontic treatment was completed, the prosthodontic phase took place

Fig. 17

Implants were used for implant-retained prostheses (abutment-cemented crowns), and a three-unit fixed partial denture pontic (crowns 25–27) was placed

Fig. 18

OPT after prosthodontic finalization

Fig. 19

A full-mouth frontal aspect

Fig. 20

The left side could not be restored to an ideal class I relationship from the original class II due to the pontic prosthesis

Fig. 21

A dental class I occlusion was established only on the right side (lateral aspect)