Forced orthodontic eruption for augmentation of soft and hard tissue prior to implant placement
A 22-year-old woman was referred to the School of Dentistry at Araraquara, with the complaint of tooth mobility in the right maxillary lateral incisor. She was also disappointed with her prosthesis. Her medical history was non-contributory and her dental history revealed a root canal therapy and provisional restoration on the right maxillary lateral incisor. Clinical examination revealed that the tooth presented degree II of mobility, 5 mm probing depth in the interproximal surface and the gingival tissue surrounding the tooth was inflamed. The temporary acrylic resin crown presented some marginal infiltration, and after removing it, a cavity was found under the gingival tissue []. Periapical radiograph revealed bone resorption around the root, interproximal angular bone defects, and satisfactory canal treatment. Because it was impossible to obtain an adequate crown-root ratio after tooth treatment, it was decided with patient to extract the root orthodontically and to replace it by a dental implant.\nIt is important to note that this case report was planned with a multidisciplinary team, i.e., orthodontist, periodontist, and prosthodontist. The initial phase of treatment occurred with the reduction of control plaque accumulation and gingival inflammation. For this patient, the periodontal treatment and oral hygiene instruction were performed during 4 months, according to Gkanditis et al.[]\nAfter 4 months, a careful clinical examination was made, the cavity was treated, the excess of gingival tissue was removed, and the temporary crown was replaced. The orthodontic treatment was initiated using the brackets with Roth prescription and the right lateral incisor bracket was positioned more cervically than those on the other tissues, in order to allow the tooth extrusion with a 0.016″ Ni-Ti wire. To help prevent intrusion of the anchorage teeth, a 0.019″ × 0.025″ stainless steel auxiliary arch was used [Figure and ]. Patient was seen every 2 weeks for reduction of the incisal surface of the extruded tooth to prevent occlusal interferences during extrusive movement. Furthermore, the lateral incisor bracket was repositioned as close as possible to the gingival margin to allow a long extruding range. Periapical radiographs were taken monthly to monitor progress in the bone profile.\nAfter 12 weeks of orthodontic extrusion, the tooth was stabilized for 4 months in order to get a proper reorganization of the soft-tissue, and bone remodeling [Figure and ]. Before extraction of the maxillary right lateral incisor, it was possible to observe, clinical, and radiographically, a substantial interproximal and vertical bone formation and an increase in the amount of attached gingiva. After 15 months of orthodontic treatment, the lateral incisor was extracted [] and an implant (3.3 mm × 11 mm implant, Neodent, Curitiba, Brazil) was placed immediately, remaining unloaded for 6 months until the osseointegration period []. The periapical radiographic evaluation showed osseointegration around of the implant 6 months after its installation []. After this time, a provisional restoration was confectioned for allowed the gingival recontouring [].\nA definitive metal-ceramic crown was installed 1 year after implant placement []. After 5-year follow-up, the patient reported no complaints, and the dental implant was stable and healthy. Patient was very satisfied with the aesthetic result.