Guided Implant Surgery for Patient Undergoing Ortho?
I have patient who is missing 22 (upper left lateral) and undergoing ortho treatment at the moment. I have treatment planned for an implant and crown. He is 2-3 month from finishing ortho. I have done implant placements with surgical guides before, but have not done guided surgery for a patient with ortho brackets. Will the surgical guide fit over the brackets? What instructions should I give the lab to make sure they make the guide to fit over the ortho brackets?
2 Comments on Guided Implant Surgery for Patient Undergoing Ortho?
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Juan Carlos Echeverri
10/26/2016
Is the patient being treated with lingual brackets? is not, then have the lab cut the stent with the incisal edges of the buccal surfaces. If the patient is still in active movement the time between the stent impression/fabrication and use has to be minimal. Otherwise it will not seat.
mpedds
10/26/2016
What's the hurry? After active ortho there is period of time when the occlusion will settle in. The teeth are held by wires and brackets for a year or more and can not fully articulate with each other until appliance removal. This means there will be subtle changes in overbite, overjet and even anterior guidance.
Also, how old is the patient? I can relate to you a case I did in 1988 where after ortho an implant was placed to replace a missing maxillary lateral incisor on a 17 year old. Things looked good for a few years and then the patient was lost to the practice. She returned 10 years later and to my dismay the occlusion had settled in and there was some relapse. This resulted in the implant restoration in labial version after the rest of the dentition had moved and the implant did not. (imagine a class2 div2 lateral) An esthetic failure for sure.
Food for thought.
