Patient was presented with a congenitally missing one upper right canine, labial profile with concavities and lack of bone thickness, labially and palatally. Implants: NobelActive NP 3.5x13mm.
An immediate implant after her orthodontic therapy was almost completed. Space was created between #12 and #14 over a period of 12 months. I would usually wait for 6 months before issuing her final prosthesis together with debonding of her brackets and provide her with a stable retainer. A total treatment time of 18 months is to be expected.
Using the standard protocol of NobelActive implant , a load-free healing period is one of the most emphasized requirements for implant integration.
At present the result shows promising data for immediately loaded single-tooth implants in the anterior maxilla. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading.
The stepped-screw type implant was inserted with an increasing torque up to 70 Ncm, thus measuring the primary stability of the implants. The implant was immediately restored with unsplinted acrylic resin provisional crown. Her final crown would be a full-contour, full strength FCZ Implant Crown. This is a CAD/CAM manufactured from translucent high-strength zirconia. 100% cement-free. My preferred implant restoration in most cases.
There are a few difficulties in multidisciplinary cases that need to be noted. One is communication between the implant surgeon, implant restorative dentist, and the person doing orthodontic work.
The other will be to get the three dental professionals to come together and coordinate their respective roles in the treatment process. Based on my experience on this kind of work, the best approach will be for the patient to seek treatment from a specialist who is trained in multidisciplinary dentistry.
This will avoid confusion to the patient as to who he or she should go for follow-up. There have been many cases where patients did not pursue follow-up treatments after both orthodontics and dental implant were completed.
For the above reason, I would seriously advise dental surgeons to pursue a double-major in both implant dentistry and orthodontics. This will enable them to give to their patients comprehensive treatment.
The practice of orthodontics and implant dentistry requires an interdisciplinary approach that integrates the knowledge, skills and experience of all the disciplines of dentistry into a comprehensive treatment plan.
If you have a good set-up and multidisciplinary dental surgeons, such as in a hospital and University, it would be ideal to have 3 dental specialists working on one case.
This article outlines a comprehensive interdisciplinary treatment philosophy designed for developing the foundations of optimal aesthetics in an orthodontics case with implant dentistry. The case presented illustrates the value and utility of interdisciplinary treatment by a single specialist with multidisciplinary experience. In this way the patient is not denied her overall dental functions, and aesthetics.