1st Molar Implant Placed Distal

A 5x10 mm implant is intentionally placed distal at #19 using guided surgery (Fig.1).  When it is osteointegrated, it will be used as an anchorage to upright the tooth #18 orthodontically.  In fact the implant is mistakenly placed 1.5 mm deeper than planned without significant side effect (red dashed line: the superior border of the Inferior Alveolar Canal).  The tooth #17 will be extracted before banding.  The healing abutment dislodges (probably as related to deep placement of the implant) 20 days postop and is retightened.  There is mild crestal bone loss 4 months postop (Fig.2).  The tooth #17 is extracted with insertion of Osteogen Plug to prevent dry socket.  A 5x4(2) mm cementation abutment will be placed with fabrication of a provisional with equi- or slightly subocclusal.  Bands and brackets will be placed at #18-22.  When open coil spring is placed between #18 and 19 with 18 ss wire, acrylic will be added to the occlusal surface of the provisional so that the tooth #18 is distalized without interference.  The tooth #18 is distalized more than 1 month post placement of open coil spring (Fig.3).  The tooth #18 is also lingually tilted (Fig.5), as compared to the contralateral side (Fig.4).  After placement of 20 ss wire and longer coil spring, an elastic is placed between the lingual cleat of #18 and the buccal (lingual) button of #15 (Fig.5) to correct the lingual tilt.  The tooth #18 is distalized ~ 1 mm shown by X-ray, although more clinically, 2.5 months post open coil spring (Fig.6).  The bone density around the implant, particularly mesial, increases, as compared to Fig.2.  The treatment finishes with normal overjet in the 2nd molars 11 months postop and 5 months post banding (Fig.7).  It appears that the buccal groove of the lower 2nd molar (Fig.8 >) has been distalized to occlude with the mesiobuccal cusp of the upper 2nd molar (^).  The width of the dense bone around the implant increases 14 months postop (3 months post cementation, Fig.9).

Lower Molar Immediate Implant, Armaments 植牙，导板与正畸  5-Year Post Cementation Xin Wei, DDS, PhD, MS 1st edition 03/30/2018, last revision 01/10/2021