Extreme lower anterior angulation?

Pt has been referred to me in order to graft with bone substitute the labial aspect of lower anterior.
She has just finished Ortho.
Does bone grafting make sense?
Is the 50 degrees angulation of the lower anterior viable?
Should I refer her to an Ortho to reposition lower anterior lingually?

Elvert Pinzon. comments:

Yo lo dejaría un año para ver cuanto hueso regenera. Muchas veces al retirar las Fuerzas que causaron el trauma, hay una remodelacion natural.

John Beckwith DMD,DABOI comments:

The lower implant should not be placed w that much angulation since that will increase forces and lead to bone loss. Labial graft is beneficial . Placing implant on less of an angle will increase over jet. Ortho should be retreated with instructions to decrease torque of lower incisors and retracting maxillary incisors for proper overjet.

Dr. Michael T comments:

Thank u for your reply. It’s not about implants. It’s about bone mechanics. The bone foundation is the problem, not the teeth. So, I would prefer to get some sort of overjet mad let the lower anterior loaded under better angulation. What do u think?

Matt Helm DDS comments:

Theoretically, that would indeed be the more sensible solution. A simple look at this one slice of scan you posted clearly shows that you have ample room and bone to choose a much more vertical insertion path for the implant than the present angle of this mandibular incisor. There is no doubt that if you attempt an implant at this angle the bone mechanics will lead to resorption of labial. However, having said all that, I remain of the opinion that this one photo is nowhere nearly sufficient for anyone of us to make anything but a purely theoretical assessment, which is rather sterile, since we lack other important info, like what the uppers look like, what the actual bite is, and so on. Try to present the big picture next time. You'll get more practical and more realistic opinions.

Dennis FlanaganDDSMSc comments:

When bone is less than 1mm CBCT is unreliable

Greg Kammeyer, DDS, MS comments:

yes, grafting makes sense. GBR with PDGF. Both anterior arches have off angle forces on bone.

Guest comments:

I don't think you will achieve bone augmentation on this buccal root surface. I agree the CBCT scan is not able to detect a thin layer of buccal bone.

More information would be beneficial. How does this incisor relate to the upper incisors? What is the occlusal contact? Where is the gingival margin on the buccal of this tooth? Is there mobility present.

Tim Carter comments:

Refer to ortho and reposition for sure