Uprighting Movement Relative to Defects Forced Eruption Alteration of the Gingival Embrasure Interactions with Implants

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1 Frank Celenza DDS Periodontist and Orthodontist Past President, Northeastern Society of Periodontists Associate Clinical Professor, New York University Member, ITI (International Team of Implantologists) Recipient, Leonard Hirschfeld Memorial Award Recipient, New York City Commendation Private Practice, 880 Fifth Avenue, New York, NY, Scarsdale, NY, and Fair Lawn, NJ

2 Ortho/Perio Uprighting Movement Relative to Defects Forced Eruption Alteration of the Gingival Embrasure Interactions with Implants Perio/Ortho Basic Therapy Open Flap Curettage Grafting Exposures Gingivectomy Fiberotomy Frenectomy

3 Good judgement comes from experience... experience comes from bad judgement. -Mark Twain

4 The Effect of Orthodontic Therapy on Certain Types of Periodontal Defects I.S. Brown, J Perio 44: , 1973

5 Predetermination of Osseous Changes Associated with Uprighting Tipped Molars by Probing Wise and Kramer Int l J Perio and Rest Dent 1/1983

6 Ritchey and Orban J. Perio; 24:75, 1953 In the absence of periodontal disease, the position of the crest is dictated by the relative positions of the cementoenamel junctions

7 Treatment Options for Extruded Molars Orthodontic Intrusion Subapical Osteotomy/Segmental Impaction Occlusal Reduction/Crown Lengthening/Elective Devitalization Extraction/Implant Replacement

8 Periodontal Response After Tooth Movement Into Intrabony Defects Polson, Nyman, et al J. Perio; 55(1):1984

9 Orthodontic Extrusion of Single-Rooted Teeth Affected with Advanced Periodontal Disease J. van Venrooy, R. Yukna AJO, Jan., 85, p. 67 orthodontic extrusion of teeth with advanced periodontal disease can have positive clinical and histologic results.

10 Uses of Forced Eruption: Soft Tissue Modification Hard Tissue Modification Implant Site Development The Development of Forced Eruption as a Modality for Implant Site Enhancement F. Celenza, Alpha Omegan, 90(2):Summer, 1997 F. Celenza, Practical Perio & Rest Dent March, 2001

11 Extraction Site Classification Salama, Salama: IJPRD:13, 1993 Type I Incipient Site: -Three or Four Walls -Good Labial Plate Type II Moderate Site: -Three Wall Defect -Compromised Labial Plate Type III Severe Defect: -Less Than Three Walls -Poor Labial Plate

12 The Development of Forced Eruption as a Modality for Implant Site Enhancement F. Celenza, Alpha Omegan, 90(2):Summer, 1997 F. Celenza, Practical Perio & Rest Dent March, 2001

13 The single most important factor for survival of the grafted tissue over the avascular root surface is adequate blood supply from the tissues adjacent to the graft bed Miller, PD Jr. Root Coverage with the Free Gingival Graft. Factors Associated with Incomplete Coverage J.Perio 87:58:

14 Gingival Margin Coordination By Semi-Lunar Incision Tarnow, JCP By Connective Tissue Graft Langer, Calagna JP By Forced Eruption Ingber IJPRD By VISTA

15 VISTA Vestibular Incision Subperiosteal Tunneling Approach

16 Spontaneous improvement of gingival recession after correction of tooth positioning Machado, MacGinnis, Damis, Moon, AJO-DO, 145(6): , June, 2014

17 Tarnow, Magner, Fletcher J. Perio, 1992 when the measurement from the contact point to the crest of bone was 5mm or less, the papilla was present almost 100% of the time.

18 Tarnow, Magner, Fletcher J. Perio, At 5mm the papilla was present 98% of the time -At 6mm the papilla was present 56% of the time -At 7mm the papilla was present 27% of the time

19 Interactions with Implants Preparatory to Implant Placement Tissue Modification Spacial Relations Utilizing Implants as Anchorage Direct Anchorage Indirect Anchorage

20 The Development of Forced Eruption as a Modality for Implant Site Enhancement F. Celenza, Alpha Omegan, 90(2):Summer, 1997 F. Celenza, Practical Perio & Rest Dent March, 2001

21 Implant Site Development by Orthodontic Forced Extraction: A Prelim Study -Amato, Tarnow et al JOMI 27(2):2012, OISD is a viable treatment for hopeless teeth to regenerate hard and soft tissue -70% efficacy for hard tissue -60% efficacy for gingival augmentation -Residual attachment level on the tooth is not a limitation

22 Classes of Orthodontic Anchorage Minimal Anchorage Posterior Protraction

23 Classes of Orthodontic Anchorage Moderate Anchorage Equal Space Closure

24 Classes of Orthodontic Anchorage Maximum Anchorage Anterior Retraction

25 within physiologic limits, rigid endosseous implants provide excellent orthodontic and orthopedic anchorage. Roberts et al, 1988,90

26 static load applied laterally to implants resulted in a structural adaptation of the peri-implant bone Gotfredsen, Berglundh, Lindhe Clin.Oral Imp..Res. 12,2001; 1-8

27 Direct Anchorage: Enhanced anchorage utilizing forces that originate from the actual implant Indirect Anchorage: Enhanced anchorage utilizing an implant to stabilize dental units which in turn serve as the anchor units

28 Implants for Tooth Movement: Determining Implant Location and Orientation -Smalley J Esthetic and Rest Dent: 7(2); 62-72, March, 1995

29 Forces Acting upon Dental Versus Orthodontic Implants Magnitude: Much higher on dental implants Duration: Dental implants receive intermittent force, Ortho is continuous Directionality: Ortho implants receive unidirectional force

30 Periodontal and Restorative Considerations in Molar Uprighting Celenza Mantzikos and Shamus Compendium of Continuing Education March,1996; p294

31 A New Device for Absolute Anchorage for Orthodontics ( OnPlant ) Block, Hoffman Am J Orthod Dent Orthopedics 1995: 107:251-8

32 OnPlant

33 The Use of Palatal Implants for Orthodontic Anchorage Design and Clinical Application of the Orthosystem Wehrbein, Merz, Diedrich, Glatzmaier Clin. Oral Impl. Res. 7: , 1996

34 OrthoSystem

35 Aspects of the Use of Endosseous Palatal Implants in Orthodontic Therapy Wehrbein, Merz J. Esthetic Dent. 10(6): , 1998

36 Game Changers in Orthodontics -Editor s Corner, JCO, May, 2012 Invisalign and TADs were clearly the major game changers in orthodontics over the past decade and a half

37 Maxillary Lateral Incisor Agenesis and its Relationship to Overall Tooth Size Wright, Bosio et al J Prosthet Dent., Feb, 2016; 115(2): Orthodontic patients with unilateral or bilateral agenesis of the maxillary lateral incisor have smaller than average teeth

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40 Dr. Vincent Kokich Sr.

41 Thank You! web: