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| 6/24/2012 10:45:54 AM | Maurice Salama | | Management of a combined vertical and horizontal bony defect with Orthodontics | | A perfect treatment plan by Henry. Very manageable if done in that way. Predictable and efficient sequencing of therapy. | | Register For Free To Reply |
| 6/26/2012 11:25:35 PM | henry salama | | Management of a combined vertical and horizontal bony defect with Orthodontics | | If you make sure your orthodontic mechanics does not inadvertently tilt the canine to the labial during the eruption phase, then there is no need for grafting prior to ortho eruption. There is a good possibility that you will gain some KT after eruption and stabilization. If not, I would perform a CT graft 3 months post-ortho.
Good luck | | Register For Free To Reply |
| 6/25/2012 6:20:23 AM | NIkolaos Markou | | Management of a combined vertical and horizontal bony defect with Orthodontics | | Dr. Salama, I would really like to thank you for the guidelines and please let me ask you one more thing.
Do you think that I have to go for increasing KT labially to the left canine before extruding it? There is complete lack of zone of KT that makes me skeptical..
Thanks in advance
Nikos Markou | | Register For Free To Reply |
| 6/22/2012 1:25:22 PM | henry salama | | Management of a combined vertical and horizontal bony defect with Orthodontics | | While the deficiency on the the mesial of the left canine is definitely the most severe, for me it is not the only one from an esthetic stand point. The central papilla is also slightly deficient and would have to be factored into any treatment plan to optimize esthetic outcome by orthodontically erupting it as well (it is also shorter than the adjacent lateral). Given that the patient is already in ortho, the following represents my sequence of therapy:
1) Orthodontic eruption of both the right central as well as the left canine. This will ensure interproximal bone support for the midline papilla as well as address the same for the canine. - Over erupt by 1 mm to over-correct;
2) Stabilize/splint ortho result for 3 months. Possibly with a fixed provisional restoration from 11 to 23 (8-11).
3) GBR area of 21 & 22 with soft tissue grafting.
4) One implant in the area of the left central #21 and cantilever #22.
By the way, consider stripping the lower incisors in order to retract them further and create the potential for a better overbite/overjet relationship.
Good luck and please share your eventual treatment. | | Register For Free To Reply |
| 6/22/2012 3:55:08 AM | NIkolaos Markou | | Management of a combined vertical and horizontal bony defect with Orthodontics | | Patient of 35 years old with severe vertical and horizontal defect in the anterior area. She is under orthodontic treatment for 2 years and the question is how predictable can it be to extrude the canine #23 in order to gain vertical bone and correct the papilla height mescal to the tooth?
What is the best treatment sequence to predict a pleasant esthetic outcome?
Ortho extrusion #23 + GBR + implant placement or
Ortho extrusion #23 + GBR + soft tissue grafting + conventional prosthetic rehabilitation? | | Register For Free To Reply |
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