Placing implants while undergoing orthodontic treatment?

how could you possibly do a correct reconstruction while teeth are still moving. implantology is a restorative driven discipline. the orthodontist should be setting up an ideal m/d width for your crown. once that is complete, then and only then will you be able to find the middle of the space to properly position the fixture to support the properly sized prosthesis. It is generally not a good idea to do multiple treatments at the same time. things go south real quick. do your perio ahead of time and not concomitant with your crown and bridge. you should be checking carefully and having good communication with the orthodontist about the space you want remaining. if not correct, ask him to change it.

Dear Colleagues, Implantology, in my opinion, should be a multi-specialty discipline. Many implant dentists still hold the belief that ALL or the majority of orthodontic movement should be completed before implant surgery is performed. I strongly disagree! I have placed implants using surgical guides (ie. Anatomage) and also freehand using the orthodontic appliance and a trimmed palatal Essix appliance as the surgical guide. Implant sites can be "over prepared" so the implant dentist can place the implant early or in the middle of orthodontic treatment. During the 4 -6 month healing and integration process the orthodontist (or better, an implant dentist trained to perform his or her own adjunctive orthodontics) can move the adjacent teeth back to their normal positions around the healing implant. I have done this on several occasions. An integrated implant can be incorporated into the orthodontic appliance to help level, open the bite, close the bite, intrude teeth and upright teeth. The orthodontist or adjunctive "orthodentist" can also enhance receptor sites and build new bone with orthodontics. In lateral agenesis cases the maxillary canines can be strategically moved to enhance the lateral sites. Waiting one to two years to place implants allows more crestal and labial bone resorption to occur. Implants have been shown to retain crestal bone. Once placed the implant will, more likely than not, eliminate bone grafting in many cases. I agree! Good communication with the orthodontist is a must! However, my dental implant colleagues should learn how to perform their own adjunctive orthodontics. Paul L. Ouellette, DDS, MS, AFAAID Orthodontics and Implant Dentistry

Thanx all for your valuable comments. No the orthodontist did not ask me to place the implants prior to ortho treatment. I was thinking that while the implants and graft are integrating, the ortho treatment could be done, to save time. My main concern was that whether the stresses generated by the ortho treatment would interfere with the osseointegration.

I have been referred several cases to restore implants that were placed prior to the start of ortho treatment. These were in young patients with congenitally missing teeth. Despite the effort, several of these implants were non-restorable due to loss of mesial-distal space. The orthodontists seemed capable but things can go wrong. I had to send them back to be bracketed up and spaces re-opened. I would recommend doing it after ortho.

Hi Arjumand, If you maintain the teeth adjacent to the implant site with open coil springs there is no reason why orthodontic tooth movement could not be carefully accomplished during the integration period in other areas of the mouth. I usually wait a minimum of three months before reducing a receptor site's MD width to the final crown dimension(s). In the meantime other areas of occlusal disharmony may be addressed. My response to mpedds to only place implants after ortho works fine if the orthodontist completely understands the implant dentist's treatment goals. It works better if you place the implants as soon as ortho is completed. But this is frequently not the case. Often there is lack of ongoing communication and sometimes a misunderstanding of how to prepare receptor sites properly. For 35 years I thought I was preparing implant sites properly, but I had many cases that experienced root relaxation, non-compliance in retention and 4 to 5 years of post ortho adverse growth changes. When I wrote my first patient refund check for $5,000, I considered this money as the first installment of learning that "special skill-set" possessed by my dental implant colleagues. I spent the next 5 years taking the Maxi course, attending ICOI and AAID meetings and other CE conferences related to implant dentistry. My proactive approach of practicing adjunctive orthodontics and placing my own implants has been extremely rewarding. Now there are no excuses or blame for who did not properly engineer implant receptor sites. Cheers, Paul.

Paul, Well stated. It is best to confer with the orthodontist and implantologist prior to starting treatment. I have a heavy ortho background and find your comments refreshing.