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 Table of Contents  
Year : 2016  |  Volume : 6  |  Issue : 2  |  Page : 316-318

New bone formation by orthodontic tooth movement for implant placement

1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
2 Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
3 Department of Restorative Dentistry, Yeditepe University, Istanbul, Turkey
4 Department of Prosthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
5 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Trakya University, Edirne, Turkey

Date of Web Publication17-Feb-2017

Correspondence Address:
Dr. Fatih Cabbar
Yeditepe University, Dis Hekimligi Fak., No: 238, Bagdat. Cd. 34728, Goztepe, Istanbul
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DOI: 10.4103/2231-0746.200332

PMID: 28299281

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Bone defects at the anterior regions of the jaws often cause esthetic problems such as gingival disharmonies and longer crowns than neighboring teeth. Variety of procedures can be used in this region for achieving sufficient bone volume with or without different bone graft materials. All of these procedures has their own advantages and disadventages. New bone formation was defined with orthodontic tooth movement in different regions. In this case we present the use of orthodontic tooth movement, for achieving sufficient bone volume, in anterior maxillary region, for esthetic and functional results.

Keywords: Dental implant, new bone formation, orthodontic tooth movement

How to cite this article:
Cabbar F, Nur RB, Dikici B, Canpolat C, Capar GD. New bone formation by orthodontic tooth movement for implant placement. Ann Maxillofac Surg 2016;6:316-8

How to cite this URL:
Cabbar F, Nur RB, Dikici B, Canpolat C, Capar GD. New bone formation by orthodontic tooth movement for implant placement. Ann Maxillofac Surg [serial online] 2016 [cited 2021 Oct 17];6:316-8. Available from: https://www.amsjournal.com/text.asp?2016/6/2/316/200332

  Introduction Top

In cases with missing maxillary incisor teeth, various treatment options such as orthodontic treatment, bridges, and implants are available. In cases in which dental implants are planned, bone volume has critical role. However, bone volume decreases after extractions.[1] Hence, proper alveolar dimensions are required for implant placement; in such cases, approaches for bone augmentation are always sought. Numerous reconstruction procedures have been proposed to increase alveolar bone volume. These techniques include guided bone regeneration, bone grafts, distraction osteogenesis, alveolar split osteotomy, and combination of these procedures. A variety of graft materials are being used in these procedures with or without barrier membranes or fixation materials.[2],[3],[4],[5]

Orthodontic tooth movement is an alternative to bone grafting. Natural remodeling of new bone formation is achieved while the tooth moves through the alveolar bone.[6],[7] Previous investigators have demonstrated successful tooth movement “with bone” into the compromised bone by applying a carefully planned force system that resulted in bodily movement with frontal bone resorption, rather than indirect bone resorption.[8],[9] Among clinicians, this approach has been well established as a method to generate new bone for pneumatized sinuses [10] and implant placement.[8],[10] It is also reported that uprighting mesially tilted molars reduce or even eliminate intraosseous defects. It can also enhance the crown-to-root ratio and restore normal occlusal function.[11],[12] The aim of this case report is to present the multidisciplinary treatment of a patient with an extracted impacted maxillary central tooth 5 years ago.

  Case Report Top

A 16-year-old male was referred to the Orthodontics Department with a complaint of missing central incisor and crowding [Figure 1]a. The occlusal and cephalometric radiographic evaluation of patient at the age of 11 showed supernumerary teeth in the right maxillary anterior region and an impacted left maxillary central, which were extracted at that time [Figure 1]b and [Figure 1]c. The orthodontic treatment plan was made with consultation of both Restorative Dentistry and Oral and Maxillofacial Surgery Department: leveling, correction of sagittal relationship, bone formation by orthodontic tooth movement of maxillary left lateral into the central tooth space, space management for lateral single implant application, and also composite resin buildup of the maxillary lateral to turn it into central tooth [Figure 2]. After leveling, the left maxillary lateral was shifted gradually to the midline on 16 × 22 stainless steel wire, with the main aim to create new bone in the extraction space, until it was approximately 1.5 mm from the mesial surface of the right central [Figure 3]. A temporary resin buildup (Z250 3M ESPE, St. Paul, USA) was made to reshape the lateral teeth. The width of right maxillary lateral was measured with digital caliper to manage the space for implant application in the opposite side. An implant (Nobel Biocare, Zurich, Switzerland) with 10 mm length and 3.0 mm diameter was placed into the opened place for the lateral teeth [Figure 4]. Hence, the gingival inflammation was observed in the maxillary anterior region; gingivectomy was performed during the osseointegration period of the implant. The definitive porcelain crown restoration with canine protected articulation and finishing of the composite resin buildup were fabricated 3 months later. After 25 months of treatment, the esthetic and functional requirements were achieved without any complication [Figure 5].
Figure 1: Initial records. (a) Maxillary occlusal photographs, (b) maxillary occlusal radiographs, and (c) cephalometric radiographs

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Figure 2: Panoramic view of bone defect at central incisor site

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Figure 3: Panoramic view after orthodontic tooth movement

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Figure 4: Panoramic view after implant placement

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Figure 5: Final intraoral photographs of the patient

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  Discussion Top

Successful results can be achieved by multidisciplinary approaches in patients with avulsed or extracted anterior teeth in the postpubertal growth period. Every department contributes to the results in its own way with the consultation to the other ones. For example, the Orthodontic Department plans the spaces between the teeth depending on the requirements of Restorative Dentistry and Oral and Maxillofacial Surgery Departments.

The treatment plan and age of patient for implant placement have been discussed in several researches.[6],[13],[14] Overall, all investigators agree with each other that in cases with congenital missing or extracted anterior teeth, the main aim of the treatment protocol is to prevent the resorption of the alveolar bone. The guidance of the neighboring teeth into the edentulous space is preferred for preventing alveolar bone resorption by several authors as an alternative to bone grafts. The roots of the neighboring teeth moving through the alveolar bone form a significant amount of bone for implant site.[6],[13],[14] Cirelli et al. concluded that teeth can be moved orthodontically with reduced but healthy periodontal tissues, without damage to the periodontal attachment level.[15] The timing for this orthodontic movement for bone formation is not clearly defined yet. Beyer et al. indicate that new bone also showed resorption after the orthodontic treatment and before implantation and advised to postpone the orthodontic treatment until the patient is old enough for implantation.[16] However, other authors claimed that the new bone is stable over long term [6],[13] and age of the patient is not a crucial factor in the decision of treatment time. In the present case, the lateral tooth was moved to midline to form new bone in extraction space. The patient was 16 years old at the beginning of the orthodontic treatment and approximately 18 at implantation stage, so no time loss occurred between treatment steps. Therefore, there is no time for possible resorption.

In relation to atrophic edentulous jaws, available data indicate that all procedures assessed are successful in terms of bone augmentation, providing a high implant survival rate, with implants placed in the augmented bone. The clinician should be aware of the outcomes of different treatment options to assess the best option in each clinical situation.[5]

We suggest that orthodontic tooth movement should be preferred if the patient will already undergo orthodontic treatment, for several reasons. Bone grafts require 6 months to 1 year before implant placement,[17] so the treatment time will be prolonged after orthodontic treatment. By orthodontic tooth movement, patient does not have to wait for this period and treatment time will be decreased. In addition, by this treatment protocol, the risk and the need for additional surgeries will be decreased. The osseous contour of anterior maxilla has a crucial role for achieving acceptable esthetic results, and orthodontic treatment has been proposed as a means of achieving a more favorable osseous contour.[15]

There are only few reports available in the literature about complications.[9],[18],[19] It is reported that some side effects, such as root resorption, pulp vitality, and perforation of sinus membrane, can cause additional complications.[20],[21] In this case report, we present orthodontic tooth movement with the generation of new bone and good osseous contour in the esthetic region without any complication. In conclusion, orthodontic tooth movement can be defined as economic and time-saving procedure and satisfactory and esthetic results can be achieved.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Carlsson GE, Bergman B, Hedegård B. Changes in contour of the maxillary alveolar process under immediate dentures. A longitudinal clinical and x-ray cephalometric study covering 5 years. Acta Odontol Scand 1967;25:45-75.  Back to cited text no. 1
Jensen SS, Terheyden H. Bone augmentation procedures in localized defects in the alveolar ridge: Clinical results with different bone grafts and bone-substitute materials. Int J Oral Maxillofac Implants 2009;24 Suppl 22:218-36.  Back to cited text no. 2
Chiapasco M, Casentini P, Zaniboni M. Bone augmentation procedures in implant dentistry. Int J Oral Maxillofac Implants 2009;24 Suppl:237-59.  Back to cited text no. 3
Aghaloo TL, Moy PK. Which hard tissue augmentation techniques are the most successful in furnishing bony support for implant placement? Int J Oral Maxillofac Implants 2007;22 Suppl:49-70.  Back to cited text no. 4
Milinkovic I, Cordaro L. Are there specific indications for the different alveolar bone augmentation procedures for implant placement? A systematic review. Int J Oral Maxillofac Surg 2014;43:606-25.  Back to cited text no. 5
Kokich VG. Maxillary lateral incisor implants: Planning with the aid of orthodontics. J Oral Maxillofac Surg 2004;62 9 Suppl 2:48-56.  Back to cited text no. 6
Zachrisson BU. Orthodontic tooth movement to regenerate new alveolar tissue and bone for improved single implant aesthetics. Eur J Orthod 2003;25:442.  Back to cited text no. 7
Zachrisson BU. Current trends in adult treatment, part 2. J Clin Orthod 2005;34:285-96.  Back to cited text no. 8
Cacciafesta V, Melsen B. Mesial bodily movement of maxillary and mandibular molars with segmented mechanics. Clin Orthod Res 2001;4:182-8.  Back to cited text no. 9
Oh H, Herchold K, Hannon S, Heetland K, Ashraf G, Nguyen V, et al. Orthodontic tooth movement through the maxillary sinus in an adult with multiple missing teeth. Am J Orthod Dentofacial Orthop 2014;146:493-505.  Back to cited text no. 10
Heasman PA, Millett DT. The Periodontium and Orthodontics in Health and Disease. New York: Oxford; 1996.  Back to cited text no. 11
Thilander B. Infrabony pockets and reduced alveolar bone height in relation to orthodontic therapy. Semin Orthod 1996;2:55-61.  Back to cited text no. 12
Novácková S, Marek I, Kamínek M. Orthodontic tooth movement: Bone formation and its stability over time. Am J Orthod Dentofacial Orthop 2011;139:37-43.  Back to cited text no. 13
Spear FM, Mathews DM, Kokich VG. Interdisciplinary management of single-tooth implants. Semin Orthod 1997;3:45-72.  Back to cited text no. 14
Cirelli CC, Cirelli JA, da Rosa Martins JC, Lia RC, Rossa C Jr., Marcantonio E Jr. Orthodontic movement of teeth with intraosseous defects: Histologic and histometric study in dogs. Am J Orthod Dentofacial Orthop 2003;123:666-73.  Back to cited text no. 15
Beyer A, Tausche E, Boening K, Harzer W. Orthodontic space opening in patients with congenitally missing lateral incisors. Angle Orthod 2007;77:404-9.  Back to cited text no. 16
Coatoam GW, Mariotti A. The segmental ridge-split procedure. J Periodontol 2003;74:757-70.  Back to cited text no. 17
Melsen B. Limitations in adult orthodontics. In: Melsen B, editor. Current Controversies in Orthodontics. Chicago: Quintessence; 1991. p. 147-80.  Back to cited text no. 18
Re S, Cardaropoli D, Corrente G, Abundo R. Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement. Clin Orthod Res 2001;4:177-81.  Back to cited text no. 19
Daimaruya T, Takahashi I, Nagasaka H, Umemori M, Sugawara J, Mitani H. Effects of maxillary molar intrusion on the nasal floor and tooth root using the skeletal anchorage system in dogs. Angle Orthod 2003;73:158-66.  Back to cited text no. 20
Wainwright WM. Faciolingual tooth movement: Its influence on the root and cortical plate. Am J Orthod 1973;64:278-302.  Back to cited text no. 21


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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