Treatment Planning for Long-Termed Missing Molars

A 44-year-old lady requests restoring missing teeth at #14 (Fig.1 *) and 30.  There is no buccopalatal width deficiency at #14, but the mesiodistal space needs to be expanded by distalizing the tooth #15 (arrow) after extraction of the tooth #16 (x).  Placement of a longest mini-implant at the tuberosity area after socket healing is anticipated.

At the site of #19, the biggest challenge is the buccolingual width.  An incision will be made to determine the width.  If it is less than 5 mm, consider Ridge Split.   Otherwise, place a UF implant at restorative position and bone graft.  Initial depth is 10 mm.

A second option for #14 is segmental orthodontic treatment.  Initially keep the tooth #16 and mesial reduction (Fig.2 *).  Place brackets between #11 and 16 (Fig.3 red) and open coil spring between #13 and 15.

When the tooth #15 is distalized (Fig.3), place an implant at #14 (Fig.4 green), parallel to the tooth #13 and extract #16 (black).  When the implant osteointegrates, place an abutment (Fig.5 pink), provisional (white) and bracket at #14.  The implant is used as an anchorage to further distalize #15 until the latter reaches the normal position (Fig.6).  CT study shows how much the tooth movement is needed prior to implantation.

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Xin Wei, DDS, PhD, MS 1st edition 11/22/2015, last revision 10/27/2016