Replacing Missing Laterals:

Transcription

1 Replacing Missing Laterals: presented by Ron Jackson, DDS, FACD, FAGD, FAACD to benefit In conjunction with January 25, 2018

2 Ron Jackson, DDS, FACD, FAGD, FAACD to benefit in conjunction with Warrenton, Virginia January 25, 2018 Friday Factoids July 28, Fiscal Year ending June 30, ,164 dental patient visits Represents 24% increase from previous year (2,550 visits) 1,269 patients seen from Fauquier & Rappahannock counties a 10.7% increase from previous year Clinic spent - $285,300 on dental care up 8% from 2016 Canine Substitution Removable Partial Denture (Flipper) Conventional 3 Unit Bridge Maryland Bridge Implant Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge) Autosomal dominant trait Occurs in over 4% of the population Females to males 2:1 2/3 have both missing upper laterals 1/2 of those with only one missing contralateral tooth is deficient or peg Canine Substitution 1) Size 2) Shape 3) Color 4) Gingival crest height 5) Function 1

3 Canine Substitution Removable Partial Denture (Flipper) Conventional 3 Unit Bridge Maryland Bridge Implant Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge) 2

4 Canine Substitution Removable Partial Denture (Flipper) Conventional 3 Unit Bridge Maryland Bridge Implant Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge) Canine Substitution Removable Partial Denture (Flipper) Conventional 3 Unit Bridge Maryland Bridge Implant Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge) Canine Substitution Removable Partial Denture (Flipper) Conventional 3 Unit Bridge Maryland Bridge Implant Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge) 3

5 Replacement of Congenitally Missing Incisors with Implant Crowns - XXXX, General Dentist Gen Dent, September/October 2008; 56 (6): Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for Younger Patients. Implants at any Age - XXXX, Periodontist Dental Products Report February 2008; it s still unclear at what age implants can be placed -. This article presents clinical evidence that implants can be successfully placed in patients younger than 18. maxillary lateral incisor implants are challenging esthetically. the amount of space is often small, the papillae are occasionally short, the adjacent roots could be too close, Vincent Kokich, DDS Advanced Esthetics & Interdisciplinary Dentistry Vol. 2, No. 2, 2006 pp. 2-7 Articles about the use of implants in adolescents: 1) Lekholm U. The Use of Osseointegrated implants in growing jaws. Int. J Oral Maxillofac Implants 1993;8: ) Westwood RM, Duncan JM. Implants in Adolescents: a literature review and case reports. Int. J Oral Maxillofac Implants 1996;11: ) Johansson G, Palmqvist S, Svenson B. Effects of early placement of a single tooth implant, A case report. Clin Oral Implants Res 1994;5: ) Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients case report. Int. J Periodont Restor Dent 1996;16: ) Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up Study European Journal of Orthodontics 23 (2001), #6 pp ) Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement. Int J Oral Maxillofac Implants 2006; 21: maxillary lateral incisor implants are challenging esthetically. the amount of space is often small, the papillae are occasionally short, the adjacent roots could be too close, the gingival levels may be uneven, and the patient could be too young. Vincent Kokich, DDS Advanced Esthetics & Interdisciplinary Dentistry Vol. 2, No. 2, 2006 pp. 2-7 Articles about the use of implants in adolescents: 1) Lekholm U. The Use of Osseointegrated implants in growing jaws. Int. J Oral Maxillofac Implants 1993;8: ) Westwood RM, Duncan JM. Implants in Adolescents: a literature review and case reports. Int. J Oral Maxillofac Implants 1996;11: ) Johansson G, Palmqvist S, Svenson B. Effects of early placement of a single tooth implant, A case report. Clin Oral Implants Res 1994;5: ) Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients case report. Int. J Periodont Restor Dent 1996;16: ) Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up Study European Journal of Orthodontics 23 (2001), #6 pp ) Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement. Int J Oral Maxillofac Implants 2006; 21:

6 Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement - Heij DG, Opdebeeck H, et.al In J Oral Maxillofac Implants 2006; 21: It should be noted that the age at which growth is complete varies widely... jaw growth may compromise the outcome of oral rehabilitation using implantsupported prostheses even if the implants are successfully integrated. Face Height and Tooth Eruption in Adults a 20-year Follow-up Investigation - Forsberg CM, Eliasson S, Westergren H Euro J Ortho (4): men and 15 women ages yrs. Significant changes in anterior facial height Dentoalveolar change indicative of continued eruption and vertical growth of the surrounding tissues. Implant in lateral position 15 year old male Age mm infraocclusion Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow Age up Study; 25 Thilander B, Odmon J, Lekholm U, European Journal of Orthodontics 23(2001), #6 pp mm infraocclusion The best method of evaluating the completion of facial growth is by superimposing sequential cephalometric radiographs taken at least one year apart.. The AVERAGE age at which facial growth stops in girls is about 17 years and in boys it is about 21 years of age.????????? Vincent Kokich, DDS Advanced Esthetics & Interdisciplinary Dentistry Vol. 2, No. 2, 2006 pp. 2-7 Articles about the use of implants in adults: 1) Bernard JP, Schatz JP. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. J Clin Periodont 2004;31(11): ) Oesterle LJ, Cronin RJ. Adult Growth, Aging and the Single-Tooth Implant. Int J Oral maxillofac Implants 2000; 15: ) Tarlow JL. The Effect of Adult Growth on an Anterior Maxillary Single-Tooth Implant: A Clinical Report. J Prosthet Dent 2004; 92: ) Zachrisson BU. Single implant supported crowns in the anterior maxilla potential esthetic long-term (> 5 years) problems. World J of Orhto 2006; 7: ) Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants. Int J Oral Maxillofac Impl 2012; 28: ) Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation. Gen Dent July/Aug 2017; dimensional craniofacial skeletal growth and remodeling are continuous throughout life 5

7 Articles about the use of implants in adults: 1) Bernard JP, Schatz JP. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. J Clin Periodont 2004;31(11): Adult Growth, Aging and the Single-Tooth Implant - Oesterle LJ, Cronin RJ Int J Oral Maxillofac Implants 2000; 15: ) Oesterle LJ, Cronin RJ. Adult Growth, Aging and the Single-Tooth Implant. Int J Oral maxillofac Implants 2000; 15: ) Tarlow JL. The Effect of Adult Growth on an Anterior Maxillary Single-Tooth Implant: A Clinical Report. J Prosthet Dent 2004; 92: ) Zachrisson BU. Single implant supported crowns in the anterior maxilla potential esthetic long-term (> 5 years) problems. World J of Orhto 2006; 7: ) Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants. Int J Oral Maxillofac Impl 2012; 28: ) Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation. Gen Dent July/Aug 2017; dimensional craniofacial skeletal growth and remodeling are continuous throughout life While the average changes are small, a patient demonstrating maximum growth may show 2 to 3mm of vertical increase in the natural teeth.. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults: A Retrospective Study -Bernard JP, Schatz JP, Christou P, et.al J Clin Periodontol 2004; 31: Young Adults (Ages 15 21) mm implant infraocclusion over 1-9 years Implant Crown #9 Female - Age Mature Adults (Ages 40 55) mm implant infraocclusion over 1-9 years Age 29 2mm Conclusions: 1) Some vertical changes small over 9 years Some vertical changes significant over 1year Highly variable 2) Mature adults can exhibit major vertical steps after anterior restorations with osseointegrated fixtures to the same extent as adolescents or young adult individuals with residual growth potential. Age 29 Implant Crown #9 Female - Age 24 2mm 6

8 Cases Courtesy of: Dr. Sverker Toreskog Age 28 At insertion.5mm short Tarlow Jeffrey, J Prosthet Dent, September 2004;92: Implant Crown #8 15 year post op (placed Age 20) Age 38 2mm short 1.5mm change Inside Dentistry, Oct. 2008, pp Courtesy Drs. Coachman, Garber, Salama Female Age 22 internal resorption #8 Age 23 Implant Crown #9 Age 33 Implant Crown 10 years post op Try-in New implant Crown General Dentistry July 2013 Zirconia Abutment with Pink Composite Immediate Post-op new crown Implant-supported Crowns in the Esthetic Zone: Long-term effects 1. Darkening ( blue-coloring) of the overlying labial gingiva 2. Progressive infraocclusion of the crown (even in mature Adults) 3. Gingival retraction and root exposure Cleaning new implant crown - Zachrisson BU World J Ortho 2006; 7:

9 Single Implant-supported Crowns in the anterior maxilla potential esthetic long-term (>5 years) problems - Zachrisson BU World J Ortho 2006; 7: the fact that the space for a missing incisor can now be substituted with an implant-supported crown does not necessarily imply that this replacement fulfills optimal esthetic requirements, and that this technique is superior to other treatment options in a lifelong perspective for the patient. If patients are immature at the end of orthodontics and will have significant facial growth, it may be appropriate to place a bonded rather than a removable retainer in order to prevent reapproximation of the central incisor and canine roots. Vincent Kokich, DDS Advanced Esthetics & Interdisciplinary Dentistry Vol. 2, No. 2, 2006 pp. 2-7 Replacement of Congenitally Missing Incisors with Implant Crowns - XXXX, General Dentist Gen Dent, September/October 2008; 56 (6): Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for Younger Patients. Implants at any Age - XXXX, Periodontist Dental Products Report February 2008; it s still unclear at what age implants can be placed -. This article presents clinical evidence that implants can be successfully placed in patients younger than year old 19 year old Canine Substitution Removable Partial Denture (Flipper) Conventional 3 Unit Bridge Maryland Bridge Implant Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge) 8

10 D2 D1 D2 D1 ~ year old Female 19 year old Female 19 year old Female Shallow Overbite Normal Overbite Deep Overbite D2 D1 D2 D1 ~ year old Female 9

11 Shallow Overbite Normal Overbite Deep Overbite Shallow Overbite Normal Overbite Deep Overbite Excess Horizontal Overjet.5 -.7mm - Shallow Overbite -.5mm excess Horizontal Overjet Shallow Overbite Normal Overbite Deep Overbite Excess Horizontal Overjet.5 -.7mm.75mm Inlay prep - Shallow Overbite.5mm.75mm -.5mm excess Horizontal Overjet depth depth 10

12 7.39 / 9.04 = 82% 6.58 / 9.04 = 72% Reduce space by ¾ mm 7.39 / 9.04 = 82% 6.58 / 9.04 = 72% 11

13 A1 A1 12

14 Apply scrubbing 15 seconds & dry 1. 2-step Self-etch 1-step Self -etch OR Universal 2. Remove air inhibited layer with alcohol pledget Apply scrubbing 20 seconds & dry Remove Air Inhibited layer With Alcohol Pledget Apply scrubbing seconds & dry Apply scrubbing 15 seconds & dry 13

15 Try-in Mock up Ivoclar OR Bisco Mock up 14

16 Optidisc (Kerr) Optidisc (Kerr) Optidisc (Kerr) Optidisc (Kerr) Optidisc (Kerr) 15

17 17 Year old Male - 2.5mm - 1.5mm 3 month post op 17 Year old Male 17 Year old Male 16

18 Add to gingival surfaces of denture teeth to maintain pontic sites Add to gingival surfaces of denture teeth to maintain pontic sites A1 Add to gingival surfaces of denture teeth to maintain pontic sites 17

19 Ultradent ( ) Star Brush 2% Chlorhexidine Ultradent Adhesive applied, dried, cured 18

20 Other Choices: RelyX Veneer (3M/Espe) Choice 2 (Bisco) Nexus 2 (Kerr) Flowable Resin 6 month Post Op Other Choices: RelyX Veneer (3M/Espe) Choice 2 (Bisco) Nexus 2 (Kerr) Flowable Resin 20 year old female Other Choices: RelyX Veneer (3M/Espe) Choice 2 (Bisco) Nexus 2 (Kerr) Flowable Resin 19

21 20 year old female Suck-down matrix on preop model Suck-down matrix on preop model Suck-down matrix on preop model Suck-down matrix on preop model 20

22 Suck-down matrix on preop model Uncured Composite in matrix Seat Matrix and Cure Fill preps with Flowable and cure 21

23 17 Year old Male 5 years post op 17 Year Old Direct Resin Veneer at 4 years 5 years post op 22

24 D2 D1 17 year old female D2 D1 ~ year old female D2 D1 ~ year old female D2 D1 ~ year old female D2 D1 ~.95 Not Desired by the Patient Restoratively Contraindicated 23

25 40 year old Ceramic Veneer Retained Bridge Fractures 12 years post op Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach; Magne P, Belser U. Quintessence year post op 24

26 20 year post op: Implant #7 placed at age 19 3mm 1mm 20 year post op: Implant #7 placed at age 19 3mm 1mm 25

27 Long-term Clinical Performance of Resinbonded Fixed Partial Dentures with Retentive Preparation Geometry in Anterior and Posterior Areas -Aggstaller H, Beuer F, et.al. J Adhes Dent 2008; 10: Retentive preparation design 88% survival at 10 years Average Survival - 16 years 20 years Longevity of fiber-reinforced composite fixed partial dentures (FRCFPD) Systematic review Survival 94.5% at 4.8 years - Ahmed KE, Li KY, Murray CA J Dent 2017; 61: 1-11 Retentive tooth preparations performed better than retainers without a preparation Conclusion: FRC FPDs demonstrated high overall survival with predictable performance outcomes FRC FPDs should no longer be considered as experimental, temporary or short term treatment modalities. Longevity Success Rate varies widely : Acknowledgment: Quint Whipple, CDT 54% failure rate over 11 months to 90% success rate over 11 years Technique Dependent

28 Alternative Bridge Design using Glass Ceramic (emax) Fifteen-year Survival of Anterior All-Ceramic Cantilever Resin-Bonded Fixed Dental Prostheses. Kern M. J Dent 2017; 56: emax (Ivoclar Vivadent) Barwacz, CA JERD 2014 Vol 26 No. 5 pp Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors - Kern M, Passia N, et. Al J Dent 2017; 65: Conclusion: Anterior zirconia ceramic cantilever RBFDPs provided excellent clinical longevity 27

29 RESOURCES The International Association of Physiologic Aesthetics (IAPA) or American Academy of Cosmetic Dentistry Annual Meeting (AACD) or Photography Equipment: Washington Scientific Camera 615 Wood Avenue Sumner, Washington or Norman Camera S. Westnedge Kalamazoo, Michigan or Photography/Software Courses: Dr. Greg Lutke Dallas Dental Solutions Plano, Texas or Photo Mounts (to send photos to patients): (UP#488 Your New Smile ) Ultradent Products, Inc or Reality and Reality Now Esthetic Dentistry Research Group (800) Journal of Adhesive Dentistry Quintessence Publishing Co., Inc. (630)

30 SELECTED BIBLIOGRAPHY 1. Lekholm U. The Use of Osseointegrated implants in growing jaws. Int. J Oral Maxillofac Implants 1993;8: Westwood RM, Duncan JM. Implants in Adolescents: a literature review and case reports. Int. J Oral Maxillofac Implants 1996;11: Johansson G, Palmqvist S, Svenson B. Effects of early placement of a single tooth implant, A case report. Clin Oral Implants Res 1994;5: Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients case report. Int. J Periodont Restor Dent 1996;16: Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up Study European Journal of Orthodontics 23 (2001), #6 pp Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement. Int J Oral Maxillofac Implants 2006; 21: Forsberg CM, Eliasson S, Westergren H. Face Height and Tooth Eruption in Adults a 20- year Follow-up Investigation Euro J Ortho (4): \ 8. Bernard JP, Schatz JP, Christou P, Belser U, Kiliaridis S Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults: A retrospective study,, J Clin Periodontol 2004 Nov; 31(11): Oesterle L, Cronin Jr. RJ, Adult growth, aging and the Single-tooth Implant, In J Oral Maxillofac Implants 2000; 15: Thilander B, Odman J, Lekholm U, Orthodontic aspects of the use of oral implants in adolescents: a 10-year follow-up study, European J Ortho 23 (2001): Tarlow J, The effect of adult growth on an anterior maxillary single-tooth implant: A clinical report, J Prosthet Dent 2004; 92: Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants. Int J Oral Maxillofac Impl 2012; 28: Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation. Gen Dent July/Aug 2017; Zachrisson BU Implant-supported Crowns in the Esthetic Zone: Long-term effects, World J Ortho 2006; 7: Zachrisson BU Single Implant-supported Crowns in the anterior maxilla potential esthetic long-term (>5 years) problems, World J Ortho 2006; 7: Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach; Quintessence Aggstaller H, Beuer F, et.al. Long-term Clinical Performance of Resin-bonded Fixed Partial Dentures with Retentive Preparation Geometry in Anterior and Posterior Areas, J Adhes Dent 2008; 10: Ahmed KE, Li KY, Murray CA Longevity of fiber-reinforced composite fixed partial dentures (FRCFPD) Systematic review, J Dent 2017; 61: Kern M., Fifteen-year Survival of Anterior All-Ceramic Cantilever Resin-Bonded Fixed Dental Prostheses. J Dent 2017; 56: Kern M., Passia N, et.al. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors, J Dent 2017; 65: Papacchini F, Dall Oca S, Chieffi N, et.al, Composite-to-Composite Microtensile Bond Strength in the Repair of a Microfilled Hybrid Resin: Effect of Surfact Treatment and Oxygen Inhibition, J Adhes Dent 2007; 9: Dudney T, Advantages and Disadvantages of Treatment Options for Congentially Missing Lateral Incisors, Inside Dentistry Sept pp