Indication for Ortho?

A 47-year-old man has history of chronic periodontitis and bruxism.  After implants at 19, 3, and 9 with improvement in oral hygiene, he has unabated wish to correct #7 cross bite (Fig.1).   The upper dental midline deviates to the right.  When the implant at #9 osteointegrates, align the mesial surface of the immediate provisional to the facial midline.

Take pre-orthodontic photos and impression for model surgery.  Warn repeatedly the patient of complications, including aggravation of chronic periodontitis and loss of several teeth.  Comprehensive orthodontics seems to be necessary (upper and lower arches).  The tooth #23 may be extracted with immediate implant.

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Xin Wei, DDS, PhD, MS 1st edition 04/22/2018, last revision 09/03/2018