Overerupted opposing teeth: recommendations?
I have a 50 year old female patient whose LL6 and 7 have been missing for some years. She has requested implants to replace these missing teeth. UL6 has over-erupted to the extent that there is reduced inter-arch space and UL7 to the extent that there is virtually no space for restoring the implants. Enameloplasty of the opposing teeth may be sufficient to create enough space for the first molar but would have to be quite aggressive for the second molar. Appearance is not an issue. She is prepared to compromise and to just have the first molar restored. but I feel this would be a half measure. What do you recommend?
11 Comments on Overerupted opposing teeth: recommendations?
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DTY
9/19/2017
Some options;
1) DO NOTHING, tell her it just won't work
2) elective endo and crowns, I hate to kill off healthy teeth, but sometimes you have to compromise for overall well being
3) extract and implant, again I emphasize that I hate to kill healthy teeth, so ...
Dr FJJ
9/19/2017
I would recommend radiographs and pictures
Merlin P. Ohmer, DDS, MAG
9/19/2017
If you can replace the 1st molar and get good occlusion, just place an implant for the 1st molar. 2nd molars frankly have minimal function. If the 2nd molar is that supererrupted, remove it. Or do nothing and let it all ride. Not placing a 2nd molar implant is hardly a compromise.
Charles Lamberta
9/19/2017
Tuff call, you have to explain that there is no easy solution. Hard to say without seeing radiographs and articulated model. Could turn out to be a nightmare especially if the over erupted teeth have brought the bone and sinus with them. Could require more rehabilitation then either you or the patient would like to get into. Good luck!
Dr. Gerald Rudick
9/19/2017
We have no photos , xrays or scan to be able to give a reliable opinion of what to do....but do consider sending her to an Orthodontist for an opinion,........they are able to intrude teeth that have become extruded.
Juan Carlos Echeverri
9/19/2017
If you have experience in orthodontics, there is and intrusion movement that will help with a situation such as this one. You need:
1)healthy periodontium on the teeth to intrude
2) TADs (Temporary anchorage devices) on both sides buccal and palatal
3) mechanical power provided by niti springs or power chain.
4) patience, as this, same as implant stability is based on bone remodeling.
It can be done but it needs the above requirements and a doctor who knows orthodontics and TAD management.
JC Echeverri DDS
Keith Hollander
9/19/2017
Although the enamoplasy of the second molar would be aggressive, at best you cold cover the exposed dentine with a bonded ceramic onlay, gold, or Zr crown. Worst case would be an exposure then amount of reduction is not an issue, after RCTx.
denis Cunneen
9/19/2017
Pretty straight forward (no X-rays or photos to complicate the discussion)
Restoration of first molar is more than adequate occlusion.
Upper second molar is entirely disposable,
You could prevent further supra eruption of the second molar. crowni the maxillary first molar with a non bonded extension , onto the adjusted medial of the Second
Richard Hughes, DDS, HFAA
9/19/2017
You got to do, what you got to do, to level the Curve of Spee.
We had a special lecture on this topic in dental school.
You most likely will have to perform endo tx with crowns on or extract the opposing teeth.
You do not want to build errors into the system.
RIchard Waghalter, DDS
9/19/2017
Mzin p2roblem is abnormal wear of teeth overt0ime and
increased contact areas. There is a need to re-establish cuspid rise and remove balancing contacts and CR-CO interferences. Re-directing the occlusal contacts along the long axis of the tooth minimizes bruxism which is detrimental to implants. Take study models and do occlusal adjustments before planning or restoring any dental implants. Ring adjustments get the patient to 'fake' tension and you will see more retrusive contacts than you had ever thought possible on the posterior teeth. ALso be aware of patients with dual bites, or very long centrics, especially class two malocclusions.
Mike
9/20/2017
Upper seconds molars entirely disposable?? If you want to compress the tmjs.
Cuspid rise is not as important as established proper maximum intercuspation position for the lower jaw.
