4 interdisciplinary treatment

Interdisciplinary Treatment: Integrating Orthodontics with Restorative Dentistry and

Periodontics, Endodontics.

M. ABOULNASER- Orthodontist, BAU, Connecticut, USA.O. SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B,

C.E.S.O.D.F , S.Q.O.D.F, Paris. France.

Plan• A-Orthodontics and Restorative Dentistry• 1 - Consequences of tooth loss• 2- Space management of Microdontia, Management of 'peg laterals'or other diminutive

teeth• 3- Implant site preparation• Orthodontic Intrusion• Orthodontic Extrusion

• B-Orthodontics with Oral Surgery• C-Orthodontics with Periodontics• D-Orthodontics with Pediatric dentistry• E-Orthodontics with Endodontics

A-Orthodontics and Restorative Dentistry

• 1 - Consequences of tooth loss• 2- Space management of Microdontia,

Management of 'peg laterals'or other diminutive teeth

• 3- Implant site preparation

1-Consequences of tooth loss

• Mesial tipping and rotations of distal molars

http://pocketdentistry.com/18-special-considerations-in-treatment-for-adults/

Loss of a lower molar can lead to tipping and drifting of adjacent teeth, poor interproximal contacts, poor gingival contour, reduced interradicular bone, and supra-eruption of opposed teeth. Note the loss of alveolar bone in the area where a

mandibular first molar was extracted

M. ABOULNASER- O SANDID Orthodontics and restorative dentistry

1a-Consequences of tooth loss

• Distal tipping and rotations of mesial teeth

http://www.columbia.edu/itc/hs/dental/D5300/Lecture%2012.DDS.Class2008.20050622.Principles%20of%20Molar%20Uprigh_BW.pdf

M. ABOULNASER- O SANDID Orthodontics and restorative dentistry

1b-Consequences of tooth loss

• Eruption of opposing tooth in edentulous space

LE MAY J-https://www.orthodontisteenligne.com/en/ortho-101-en/adult-orthodontics-4/

Loss of posterior teeth in an adult. On one side (A), the loss of a lower molar allowed the other molars to tip forward. On each side (A and B), the upper molars migrate toward the space below (extrusion).

M. ABOULNASER- O SANDID Orthodontics and restorative dentistry

1c-Consequences of tooth loss

Gingival tissues become folded, and pockets form in the area

M. ABOULNASER- O SANDID Orthodontics and restorative dentistry

1d-Consequences of tooth loss

This photo shows a lower ridge that has lost 60% of its width following an extraction and normal healing. The black arrows indicate where bone is

located (compare the width to the adjacent molar). The red arrows indicate the normal width that should be there.

M. ABOULNASER- O SANDID

http://www.pittsburghdentalimplants.com/dental-implants/effects-of-tooth-loss/

Orthodontics and restorative dentistry

1e-Consequences of tooth loss

Occlusal Interferences and Temporomandibular Joint Disorders

M. ABOULNASER- O SANDID

http://www.dr-adrianbecker.com/page.php?pageId=281&nlid=50

Orthodontics and restorative dentistry

1f-Consequences of tooth loss

Accumulation of plaque in pockets leads to periodontal damage, with loss of gingival attachment and alveolar bone loss

M. ABOULNASER- O SANDID Orthodontics and restorative dentistry

1g-Loss of the mandibular first molar-46

Occlusal interferences - Overerupted 16- Gum pocket 47- Distalization 45- Exaggerated curve of Spee

M. ABOULNASER- O SANDID Orthodontics and restorative dentistry

1h-Tooth loss and ImpactionOrthodontics and restorative dentistry M. ABOULNASER- O SANDID

1i-Uprighting the dental axes

http://pocketdentistry.com/18-special-considerations-in-treatment-for-adults/

Orthodontics and restorative dentistryM. ABOULNASER- O SANDID

1k-Uprighting the dental axes – Mini -Implant

https://www.researchgate.net/figure/26791749_fig7_Fig-7-Patient-2-schematic-illustration-of-biomechanics-for-molar-uprighting-and /

Orthodontics and restorative dentistry M. ABOULNASER- O SANDID

1l-Intrusion of Overerupted Molars using Miniscrews

http://www.jcdr.net/article_fulltext.asp?id=6165

Orthodontics and restorative dentistry M. ABOULNASER- O SANDID

1m-Intrusion of Overerupted Molars using Miniscrews

http://www.jcdr.net/article_fulltext.asp?id=6165

Orthodontics and restorative dentistry M. ABOULNASER- O SANDID

1n-Implant site preparation

Dr LEMAY-@ortholemay.com

Molar Uprighting, with space creation 

Orthodontics and restorative dentistry M. ABOULNASER- O SANDID

1p-Missing upper lateral incisors

Kazemi, https://www.facialart.com

Orthodontics and restorative dentistry

IMPLANT SITE PREPARATION

M. ABOULNASER- O SANDID

1q-Missing upper lateral incisorsOrthodontics and restorative dentistry

Closure space

http://www.scielo.br/pdf/jaos/v22n5/1678-7757-jaos-22-05-0465.pdf

M. ABOULNASER- O SANDID

1s- Managing the orthodontic-restorative patient

Early Tooth Loss and Space Maintenance Space regaining: Molar Uprighting and Distalization

Early tooth loss can be a result of traumatic avulsion or extraction of carious or infected teeth, Premature loss of primary teeth can result in a loss of arch length and have a negative effect on

occlusion and alignment, often increasing the need for orthodontic treatment.

Orthodontics and restorative dentistry M. ABOULNASER- O SANDID

2-Multi-disciplinary approach for space management of Microdontia

- A minimal reduction was needed for lateral incisors. - Veneers cemented on lateral incisors. - Definitive composite restorations after finishing and polishing procedures.

M. ABOULNASER- O SANDID

2a-Anterior Space Management

https://www.researchgate.net/figure/235394688_fig1_Figure-2-Occlusal-view-showing-spaces-between-maxillary-central-incisors-and-

between

Occlusal view showing spaces between maxillary central incisors, and between lateral incisors and canines.

Orthodontics and restorative dentistry Management of 'peg laterals'or other diminutive teeth

M. ABOULNASER- O SANDID

2b-Anterior Space Management

https://www.researchgate.net/figure/235394688_fig1_Figure-2-Occlusal-view-showing-spaces-between-maxillary-central-incisors-and-between

Orthodontics and restorative dentistry

Management of 'peg laterals'or other diminutive teeth

M. ABOULNASER- O SANDID

2c-Anterior Space Management

Additional orthodontic treatment is initiated to improve the dental midline and evenly distribute the space around the microdontic lateral incisors

Orthodontics and restorative dentistry

Management of 'peg laterals'or other diminutive teeth

M. ABOULNASER- O SANDID

3-Implant site preparation

Move the roots from implant site, To create space priorimplant placement, the roots of the adjacent teeth should be upright and parallel

Dr Jebin

M. ABOULNASER- O SANDID

3a- Implant site peparation

Dr LEMAY-@ortholemay.com

Molar Uprighting, with space creation 

M. ABOULNASER- O SANDID

3b-Implant site preparation

Dr LEMAY-@ortholemay.com

Root parallelism

M. ABOULNASER- O SANDID

3c- Implant site preparation

Yvon Roberge, Sylvain Gagnon, Orthod Fr 2008;79:55–57

Implant site preparation : Open Space, Root proximity, Bone quality, implant types…

www.orthofree.com

M. ABOULNASER- O SANDID

3d-Implant site preparationM. ABOULNASER- O SANDID

Orthodontic extrusion

• Orthodontic extrusion uses “orthodontic forces”.

• The PDL including alveolar bone follows the extruding tooth

• Rapid extrusion uses heavier forces, more frequent activations and results in extruding the tooth beyond the PDL – lengthen clinical crown

Orthodontic extrusion

www.orthofree.com

Orthodontic extrusion uses “orthodontic forces”. The PDL including alveolar bone follows the extruding tooth

Rapid extrusion uses heavier forces, more frequent activations and results in extruding the tooth beyond the PDL – lengthen clinical crown

Retention periodDr Jebin

M. ABOULNASER- O SANDID

Orthodontic extrusion

• (a) Buccal view of the fractured premolar, (b) Occlusal view, (c) Initial radiographic appearance, (d) Initial orthodontic root extrusion of the premolar, (e) Buccal view of the orthodontic apparatus, (f) Stabilization of the

orthodontic extrusion over 5 months

http://www.jidonline.com/viewimage.asp?img=JInterdiscipDentistry_2012_2_3_221_113270_u1.jpg

M. ABOULNASER- O SANDID

Combined endodontic-orthodontic and prosthodontictreatment of fractured teeth

• Fractured teeth- Orthodontic extrusion

M. ABOULNASER- O SANDID

Orthodontic Treatment in Periodontally Compromised Patients

• Patient with advanced periodontitis and migration of the maxillary left central incisor,

• Clinical view after the end of the orthodontic treatment the teeth are retained by means of a resin-bonded splints

• Biomechanics used to intrude and move the central incisor into the defect

M. ABOULNASER- O SANDID

Orthodontic Treatment in Periodontally Compromised Patients

• Radiographic view of the osseoous defect ,• Radiographic wiew at the end of the treatment with reduction of the defect

Stefanis Re, Giuseppe CorrenteIJP and DR

Orthodontic treatment - Periodontal pocket reduction

M. ABOULNASER- O SANDID

Orthodontic Treatment in Periodontally Compromised Patients

Orthodontic treatment - Periodontal pocket reduction

Stefanis Re, Giuseppe CorrenteIJP and DR

M. ABOULNASER- O SANDID

Crown lengthening

• Crown lengthening is as a viable procedure that enables to restore teeth having a short clinical crown,

• extensive subgingival caries, subgingival tooth fractures at dentogingival junction, when performed in ideal clinical conditions…

Before crown lengtheninig After crown lengtheninig

M. ABOULNASER- O SANDID

Crown lengthening

Orthodontic Forced Eruption Combined with Circumferential Fiberotomy

http://drromanmelnyk.com/crown-lengthening/

M. ABOULNASER- O SANDID

Orthodontic intrusion

• intrusion

M. ABOULNASER- O SANDID

References • http://www.dentistrytoday.com/orthodontics?start=20

• http://www.slideshare.net/almuzian/orthodontics-and-restorative-dentistry-by-almuzian-36418366• http://www.semortho.com/article/S1073-8746(97)80034-5/abstract• https://www.orthodontisteenligne.com/cas-traites-2/multidisciplinaire/• http://pocketdentistry.com/11-interdisciplinary-orthodontics/