Bite Cross Correction with Implants as Anchors

A 40-year-old man had automobile-related mandibular fracture and surgical reduction several years ago.  Since then there has been cross bite in the left molar region (Fig.1-2) with abnormal wear facets in the occlusal surface of the teeth #14, 15 and 18 (Fig.3,4 *).  At the time of implant placement at #19, the patient reports tooth sensitivity at #15 and wonders whether increase in the occlusal surface of the future crown at #19 can alleviate the tooth sensitivity or not.  In fact the tooth #14 and 19 were in cross bite when the sites of #20 and 21 were processed for implant crowns (Fig.1).  The cross bite of the left molar area appears to be so severe that surgical segmental osteotomy or orthodontic treatment is required (Fig.5-7).

For the upper arch, implants are to be placed at #8-13.  The provisional crowns are going to be fabricated so that the buccal surface is a little more buccal.  With full arch brackets and bands and possible palatal expander, the teeth #14 and 15 are buccally repositioned.

In the lower arch, the buccal surface of the crowns at #20 and 21 is reduced substantially so that the crowns functions as lingual anchorage.  The abutment at #19 will be changed to an angled one; in the same way, the temporary crown at #19 is lingually positioned.  With full arch brackets and bands, the tooth #18 is expected to be lingualized (Fig.6 arrows).  Elastics can be placed between the left upper and lower molars (from upper lingual to lower buccal) to facilitate mutual shifting.

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Xin Wei, DDS, PhD, MS 1st edition 02/05/2017, last revision 02/05/2017