Importance of 3 D Image in Mini-implant Placement Design

Prior to placement of implants at the sites of #30 and 31, the teeth #2 and 3 should be intruded with the aid of 3 mini-implants (Fig.1.2).  CBCT axial section provides the most relevant information as to where to place them (Fig.3,4).  It appears that the buccal (B) proximal space between #2 and 3 is the narrowest (Fig.4), where placement should be avoided.

Two of 1.6x6 mm and one of 1.6x8 mm implants are partially placed buccally and palatally (P), respectively (Fig.5).  It appears that the one in the middle (^) should be redirected more distally.

Power chain x9 is placed around these 3 implants when they are fully placed (Fig.6,7).  In fact the most distobuccal implant is dislodged.  Segmental brackets and bands are supplemented for orthodontic intrusion without effect.

Intrusion turns out to be extremely difficult with the mini implants and limited traditional orthodontic appliance.  Finally a provisional has to be fabricated on the opposing implant for intrusion.  Fourteen-month combination approaches (more thanks to patient's cooperation) results in #3 intrusion (Fig.8).

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Xin Wei, DDS, PhD, MS 1st edition 07/15/2015, last revision 06/25/2017