Interdisciplinary Treatment Of An Adult With A Debilitated
Interdisciplinary Treatment Of An Adult With A Debilitated Dentition Names of Clinicians Date Rationale Occasionally orthodontists will be challenged to treat adult patients who not only have a malocclusion, but also have a myriad of other
dental problems that complicate the plan for the orthodontist. These patients require interdisciplinary treatment often involving periodontal therapy, jaw surgery, endodontic therapy, and restorative dentistry in addition to the orthodontics. The following case will illustrate how a team can manage these types of multidisciplinary problems. Background Information
1. 2. 3. 4. 5. 6. 34 years 8 months of age Doesnt want to lose her teeth Medical history is noncontributory
Recently treated by a periodontist No temporomandibular joint symptoms Cost of treatment is not a problem Periodontal Status 1. 2. 3. 4. 5.
6. 7. Moderate periodontitis Now seeing periodontist routinely Significant anterior bone loss Guarded prognosis lower incisors Gingival grafting in lower anterior Class III furca lower left first molar Moderate anterior tooth mobilities
Significant anterior bone loss Guarded prognosis lower incisors Class III furca lower left first molar No endodontic problems Supereruption lower left premolar Treatment Objectives 1. 2. 3.
4. 5. 6. 7. Align the teeth Improve periodontal health Reduce anterior overbite Reduce anterior overjet Facilitate future restorations
Improve facial profile Establish good interdigitation Treatment Alternatives 1. Non extraction approach. Align both arches, close part of the upper spaces to reduce the overjet. Place two implants on the left side and one implant on the right side. Restore remaining teeth as necessary. 2. Extract mandibular right and left first premolars, close lower and upper extraction sites and leave space for a single-tooth implant in
the maxillary left canine region. 3. Extract mandibular central incisors and close the mandibular space orthodontically. Then perform maxillary posterior segmental surgery to close the maxillary posterior spaces from the distal and a sagittal split osteotomy to lengthen the mandible. Restore the maxillary arch with a conventional fixed prosthesis to replace the missing canine. Treatment Results Pretreatment
Preoperative/Posttreatment Pretreatment Posttreatment Conclusions is patient was treated with a combined
proach of orthodontics, jaw surgery, riodontal maintenance, and eventual storative dentistry. The extraction of r mandibular central incisors was strumental at eliminating two hopeless eth and allowing her to maintain her tural mandibular teeth.
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