Severe Supraeruption

Two days post #31 implant placement, the patient returns for orthodontic intrusion of the tooth #2 with mini-implants (Fig.1).  The palatal cusps have been trimmed (Fig.2 ^), since they almost contact a healing abutment at #31(*, Fig.3). Two mini-implants are to be placed mesiobuccal and distopalatal to the affected tooth.  After minimal injection of Lidocaine, a 1.6x6 mm Tomas implant is placed in full length mesially (Fig.4), while the other (1.6x8 mm) half way (Fig.4).  Following change in implant site mesially (Fig.6 >), the implant is half inserted (Fig.5).  It appears that the tip of the distal implant is toward the tooth #1 (Fig.5).  After withdrawing the implant partially, it is re-directed to apparently ideal trajectory (Fig.7).  Ideally the mesial implant (Fig.8) should have been placed partially initially (Fig.4,5,7) so that the trajectory could have been able to be changed.

Once the tooth #2 is partially intruded, an abutment will be placed at #31.  A provisional at #31 will be used to intrude the opposing tooth.  The tooth #1, as a guiding plane (to prevent #2 from distalization during intrusion), will be extracted after intrusion is completed. 

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Xin Wei, DDS, PhD, MS 1st edition 03/17/2017, last revision 04/30/2017