AAO Meeting Mutilated Dentition in Aging Population

Transcription

1 AAO Meeting 2018 Mutilated Dentition in Aging Population 1. Introduction & Presentation 2. Anterior Missing Teeth 3. Posterior Missing Teeth 4. Analyze, Visualize and Optimize 5. Case Presentation 6. Challenge & Conclusion Intra-Oral A-P Intra-Oral A-P Intra-Oral A-P

2 1. Introduction & Presentation 2. Anterior Missing Teeth 3. Posterior Missing Teeth 4. Analyze, Visualize and Optimize 5. Case Presentation 6. Challenge & Conclusion

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4 1. Introduction & Presentation 2. Anterior Missing Teeth 3. Posterior Missing Teeth 4. Analyze, Visualize and Optimize 5. Case Presentation 6. Challenge & Conclusion

5 December 12, Y 2M 24 months post-tx March 20, Y 6 M 11 Y 4 M post-tx 1. Introduction & Presentation 2. Anterior Missing Teeth 3. Posterior Missing Teeth 4. Analyze, Visualize and Optimize 5. Case Presentation 6. Challenge & Conclusion

6 Initial Records 38Y 2M X Initial Records X X X Duplicated model Tooth set up Diagnostic wax set up Model rim and occlusal surfaces registration with heavy putty Transfer to the original model Transfer of duplicated teeth Interfering teeth clearance

7 Surgical guide preparation Putty adaptation confirms transfer precision and adequate tooth clearance Same procedure for mandible For the Mandibule Wax up must relate to alveolar ridge 1. Introduction & Presentation 2. Anterior Missing Teeth 3. Posterior Missing Teeth 4. Analyze, Visualize and Optimize 5. Case Presentation 6. Challenge & Conclusion Class III -Obstructive Sleep Apnea Initial Panogram 51 ans Classe III Initial

8 Initial Cephalogram Ceph Tracing (Initial) Patient needs Patient needs 1. maxillary expansion 1. maxillary expansion 2. maxillary advancement Patient needs Patient needs 1. maxillary expansion 2. maxillary advancement 3. lower dental asymmetry correction 1. maxillary expansion 2. maxillary advancement 3. lower dental asymmetry correction 4. incisor compensation correction

9 Patient needs 1. maxillary expansion 2. maxillary advancement 3. lower dental asymmetry correction 4. incisor compensation correction 5. good perio management Patient needs 1. maxillary expansion 2. maxillary advancement 3. lower dental asymmetry correction 4. incisor compensation correction 5. good perio management 6. dental arch coordination Patient needs Patient needs Now in which order 1. maxillary expansion 2. maxillary advancement 3. lower dental asymmetry correction 4. incisor compensation correction 5. good perio management 6. dental arch coordination 1. maxillary expansion 2. maxillary advancement 3. lower dental asymmetry correction 4. incisor compensation correction 5. good perio management 6. dental arch coordination 1. good perio management 2. incisor compensation correction 3. lower dental asymmetry correction 4. maxillary expansion SARPE 5. pre-op dental arch coordination 6. maxillary advancement Vs Bi-Max 7. teeth replacement and cosmetic dentistry 7. teeth replacement and cosmetic dentistry 7. post-op ortho finishing phase 8. teeth replacement and cosmetic dentistry Lower Dental Asymmetry Correction Clinical Progress O X O O age: 52 Y 7 M. 5 M Stade of traitement: Maxillary:.021 X.025 Post, reduced Maxillary: Space closure Mandibule:.018 X.025 SS Mandibule: Arch Form coordination

10 Clinical Progress 5 M age: 52 Y 7 M. Stade of traitement: Maxillary:.021 X.025 Post, reduced Maxillary: Space closure Mandibule:.018 X.025 SS Mandibule: Arch Form coordination Clinical Progress Clinical Progress Clinical Progress 1 Week post SARPE 10 M age: 53 Y 1 M. Maxillary:.021 X.025 SS Post, reduced Mandibule:.021 X.025 SS Post, reduced Stade of traitement: Maxillaire: Space closure and Arch Form coordination Mandibule: Space closure and Arch Form coordination

11 RC H CE MA HP R RE T CA D TP Clinical Progress Clinical Progress 6 Weeks post SARPE 1Y1 M 6 Weeks post-surgery 8.8 mm expansion Maxillary: Age: 53 Y 3 M..018 X.025 SS segmented Maxillary: Stade of traitement: Expansion stabilization Madibule:.021 X.025 SS posterior reduced Mandibule: Posterior space closure AP Cephalogram Panogram Comparison Clinical Progress Clinical Progress 1 Y 2 M 1 Y 5 M Age: 53 Y 4 M Stade of traitement: Age: 53 Y 8 M Stade of traitement: Maxillary:.016 NITI Maxillary: Alignment Maxillary:.018 X.025 SS Maxillary: Space closure Mandibule:.021 X.025 SS posterior reduced Mandibule: Posterior space closure Mandibule:.018 NITI Mandibule: LL8 Alignment

12 RC H CE MA HP R RE T CA D TP Clinical Progress Clinical Progress 1 Y 8 M Expansion screw removed 1 Y 10 M Age: 53 Y 11 M Stade of traitement: Age: 54 Y 1 M Stade of traitement: Maxillary:.018 X.025 SS Maxillary: Space closure Maxillary:.021 X.025 SS Maxillary: Ach form coordination, Dental decompensation Mandibule:.018 X.025 SS Mandibule: Ach form coordination Mandibule:.021 X.025 SS Mandibule: Ach form coordination, Dental decompensation Clinical Progress Class III -Obstructive Sleep Apnea 2 Y Pre-op records Age: 54 Y 3 M Maxillary:.021 X.025 SS Mandibule:.021 X.025 SS Stade of traitement: Maxillary: Ach form coordination, Dental decompensation Mandibule: Ach form coordination, Dental decompensation 54 Y 3 M Class III Pre-op Class III -Obstructive Sleep Apnea Panogram Comparison

13 Initial Cephalogram Pre-op Cephalogram Ceph Tracing (Pre-op) STO STO LeFort I 11.0 mm Advancement LeFort I 11.0 mm Advancement Pre-Op Appointment Trillium Hooks 2 Y 3 M Pre-op Appointment Age: 54 Y 6 M Maxillary:.021 X.025 SS Mandibule:.021 X.025 SS Stade of traitement: Maxillary: Trillium Surgical Hooks Mandibule: Trillium Surgical Hooks

14 Post-Op Appointment 3 weeks post-op Post-Op Appointment 2 Y 5 M 6 Weeks Post-Op LeFort I 10 mm advancement 4 mm Anterior Impaction 2.5 mm post. left Impaction Age: 54 Y 8 M Maxillary:.021 X.025 SS Mandibule:.021 X.025 SS 1,5 mm post. right Impaction BSSO 2,0 mm lateral right Stade of traitement: Maxillary: Surgical Consolidation Mandibule: Surgical Consolidation Post-Op Appointment Post-Op Appointment Post-Op Appointment Debonding Appointment 2 Y 10 M Debonding App. Age: 55 Y 1 M Maxillary: VFR Mandibule: VFR Stade of traitement: Maxillary: Retention Mandibule: Retention

15 RC H CE MA HP R RE T CA D TP RC H CE MA HP R RE T CA D TP Final Post - Retention 55 Y 7 M 6 Months Post-Debonding 57 Y 4 M 2 Y 4 M Post-Debonding Panogram Comparison Panogram Comparison Initial Cephalogram Final Cephalogram Pre-Op Cephalogram Final Cephalogram LeFort I 10 mm advancement 4 mm Anterior Impaction 2.5 mm post. left Impaction 1,5 mm post. right Impaction BSSO 2,0 mm lateral right LeFort I 10 mm advancement 4 mm Anterior Impaction 2.5 mm post. left Impaction 1,5 mm post. right Impaction BSSO 2,0 mm lateral right

16 Final Cephalogram Post-Retention Cephalogram Initial Pre-Op Final LeFort I 10 mm advancement 4 mm Anterior Impaction 2.5 mm post. left Impaction 1,5 mm post. right Impaction BSSO 2,0 mm lateral right Initial Final Post-Retention Initial Pre-Op Final Initial Final Post-Retention Intra Oral Sequence initial.021x.025 SS post. red. /.018 X.025 SS U/L.021X.025 SS post. red..018x.025 SS /.021X.025 SS post. red. SARPE U/L.021X.025 SS U/L.021X.025 SS

17 Intra Oral Sequence Intra Oral Sequence U/L.021X.025 SS Final Post-restoration initial.021x.025 SS post. red. /.018 X.025 SS U/L.021X.025 SS post. red. Post-Retention.018X.025 SS /.021X.025 SS post. red. SARPE U/L.021X.025 SS U/L.021X.025 SS Intra Oral Sequence Intra Oral Sequence U/L.021X.025 SS Final Post-restoration initial.021x.025 SS post. red..021x.025 SS post. red. Post-Retention.018 X.025 SS segmented.021x.025 SS.021X.025 SS Intra Oral Sequence Intra Oral Sequence initial VFR.0215 Penta twist initial.021x.025 SS post. red..021x.025 SS post. red..021 X.025 SS post. red..021x.025 SS.021X.025 SS Post-Retention

18 Intra Oral Sequence 1. Introduction & Presentation 2. Anterior Missing Teeth 3. Posterior Missing Teeth 4. Analyze, Visualize and Optimize.021X.025 SS VFR.0215 Penta twist 5. Case Presentation 6. Challenge & Conclusion Post-Retention Cream of the crop: severe mutilation redemption AIMS: -correct masticatory difficulties -establish occlusal stability & comfort -restore dental & facial aesthetics -replace missing teeth with fixed appliances CHALLENGES : -severe dento-alveolar mutilation & compensation -critical anchorage insufficiency -dental & skeletal closed bite -high patient expectations / multiple missing teeth mesial tipping #17, 28, 38, 47 localized perio conditions mild root resorption incisor attrition dento-alveolar supra-eruption

19 Mandibular dento-alveolar retrusion Brachycephaly ( FMA :17 ) U/ incisor linguoversion (I/ SN : 72 ) U/L incisor supra eruption /L molar mesial tipping 1.Initial periodontal assesment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics 8.Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention 14.Periodontal & general follow-up 1.Initial periodontal assesment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics 1.Initial periodontal assesment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics

20 1.Initial periodontal assesment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics 1.Initial periodontal assesment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up Transfer to original models 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics Surgical guide orthodontic anchorage Occlusal plane

21 1.Initial periodontal assessment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics 1.Initial periodontal assessment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics 1.Initial periodontal assessment & stabilization 2.Pre-implant alveolar & sinus grafts 3.Diagnostic wax-up 4.Implant surgical guide 5.Implant insertion # Interim temporization 7.Pre-surgical orthodontics

22 This is Flawless orthodontic design Light & constant orthodontic forces Efficient orthodontic appliances Flawless orthodontic design Light & constant orthodontic forces Efficient orthodontic appliances

23 Pre-op ortho objectives level curve of Spee decompensate incisors parallel roots Gummy Smile! Incisor intrusion! Corrected occlusal plan coordinate dental arches level dento-alveolar bone margins align marginal muco-gingival contours initial pre-op Initial Pre-op STO U/L incisor decompensation Bilateral sagittal split osteotomy 9.Post-op orthodontics Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention 14.Periodontal & general follow-up STO : mandibular advancement with clockwise rotation

24 8.Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention 14.Periodontal & general follow-up Post-op ortho. Post-op ortho. -surgical stabilisation -surgical stabilisation -ortho fine tuning to prostho requirement -ortho fine tuning to prostho requirement -ortho provisions for retention -ortho provisions for retention -perio touch-up for prostho gingival optimization -ortho fine tuning to prostho requirements 8.Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up incisor w/l ratio adjustment transverse correction 11.Final temporization 12.Final restorations final occlusal plane tuning 13.Orthodontic retention left posterior open bite closure maximal intercuspation seating 14.Periodontal & general follow-up -prostho clearance for final ortho

25 8.Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention 14.Periodontal & general follow-up appointment synchronisation: Correction des Proportions 1) debonding Correction Transversale 2) crowns prep/temp 3) temporary acetates Finalisation du Plan Occlusal Fermeture de l Occlusion Ouverte Obtention de l Intercuspidation 8.Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention 14.Periodontal & general follow-up 4 months latency on temps Correction des Proportions Correction Transversale Finalisation du Plan Occlusal Fermeture de l Occlusion Ouverte Obtention de l Intercuspidation 8.Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention 14.Periodontal & general follow-up mechanical retention designed in final crowns

26 mechanical retention designed in final crowns fixed lingual retainer # Bilateral sagittal split osteotomy 9.Post-op orthodontics 10.Prosthodontic wax-up 11.Final temporization 12.Final restorations 13.Orthodontic retention fixed lingual retainer # Periodontal & general follow-up initial pre-op final post-op

27 Post- Treatment Records Looking back in the mirror... Mandibular vertical dento-alveolar Age: 62 Y 7 M 4 Y 5 M Post-Retention Micro-Screw Intrusive Force Conclusion: -uncompromising result through a combination of basic and technical knowledge and skills, -but even more so, through constant dialogue and interaction within a multidisciplinary team Post- Treatment Records Age: 66 Y 9 M P.S.: -ideal planet alignment for a stable high quality result fulfilling all our initial aims and the patient s expectations 8 Y 7 M Post-Retention

28 Definition : Mutilated Dentition in Aging Population A coordinated venture centred on patients needs and means aimed at creating or restoring optimal function, aesthetics and stability in a compromising or unbalanced oro facial environment Thank you! fberube@me.com