Interdisciplinary rehabilitation for mutilated dentition with mini-implants, autotransplants, and a dental implant

Multidisciplinary approach involving strategic implant placement before orthodontic (SIMBO) treatment for generalized stage IV grade C periodontitis: A case report with 10‐year follow‐up

“…Furthermore, severe periodontitis frequently provokes tooth displacement such as pathologic tooth migration (PTM) 2,3 accompanied by undesirable esthetics and masticatory functional disorders characterized by flaring of the maxillary anterior teeth, frontal crowding and/or posterior bite collapse. Interdisciplinary (i.e., periodontal, orthodontic, restorative, and prosthodontic) treatments are generally accepted as necessary to achieve ideal treatment outcomes for patients with severe periodontitis 4–12 …”

“…As a result, tooth movements including molar distalization, retraction of anterior teeth, and intrusion pose challenging problems. In these cases, temporary anchorage devices (TADs) or orthodontic miniscrews can be used as anchorage for these types of tooth movements even in edentulous areas with limited availability of alveolar bone support 7,11,17,18 . However, complications such as soft tissue inflammation, root damage, TAD implant fracture, and miniscrew loosening can decrease TAD stability for orthodontic anchorage and may lead to treatment failure 19,20 …”

“…necessary to achieve ideal treatment outcomes for patients with severe periodontitis. [4][5][6][7][8][9][10][11][12] Although the substantial elimination of plaque is pivotal to establishing an ideal oral environment for predictable oral rehabilitation in periodontitis patients, regeneration of periodontal tissue is considered the ultimate goal of periodontal therapy. 9,13 Considerable progress has recently been made in periodontal regenerative/reconstructive therapies such as minimally invasive surgery using a microscope and micro instruments, offering favorable clinical and radiographic outcomes for various periodontal defects.…”

“…In these cases, temporary anchorage devices (TADs) or orthodontic miniscrews can be used as anchorage for these types of tooth movements even in edentulous areas with limited availability of alveolar bone support. 7,11,17,18 However, complications such as soft tissue inflammation, root damage, TAD implant fracture, and miniscrew loosening can decrease TAD stability for orthodontic anchorage and may lead to treatment failure. 19,20 Use of a periodontal prosthesis has resolved many problems for patients with advanced loss of the periodontium and multiple missing teeth.…”

“…4,7,8,[25][26][27] In interdisciplinary treatments for periodontally compromised patients, implant placement has usually been performed following orthodontic therapy to accomplish predictable oral rehabilitation. 4,9,11,12 However, definitive pre-orthodontic implant placement (POIP) can currently be performed as a different protocol using a pre-orthodontic diagnostic cast, orthodontic setup model, diagnostic wax-up and surgical template 7,8,[25][26][27][28] in partially edentulous patients. However, POIP for patients with severe periodontitis and PTM has yet to be established, and long-term (>10 years) clinical outcomes following this approach have not been reported.…”