Patient with low lip line and bone loss: how to manage this case?

Orthodontics to correct the malocclusion the implants as planned are flared and will take the full force of the lower teeth. Usually a high lip line is associated with a gummy smile. Any grafting or ridge splitting will be compromised by the malocclusion. There is not enough space for two implants. At least get the arch in the ballpark before grafting and planning implants.Could be a case for Surgical assisted ortho with corticotomies and grafting. I 'd find an orthodontist maybe a perio or oms familiar with this to set you up for the implants.Good case,good luck.

The flipper tooth is in malocclusion III like the adjacent central. Another position (X-ray model in normal occlusion) will be esthetically inappropriate. You need to begin with wax-up depending on the patient’s desire. But, in any case, a future implant-supported crown won’t surpass this flipper cosmetically.

An orthodontic consultation should be considered. Fixed bridge treatment should also be seriously considered after orthodontic treatment. Implant treatment is viable, but the patients smile line and malocclusion are serious considerations.

I think u mean high lip line..orthodontic consultation..consider bone grafting and implants or fixed bridge afterwards.. Implants in the esthetic zone are the hardest to restore even with good bone volume..Best of Luck!

Thanx for posting, but two implants in malocclusion in a one tooth space is practice suicide. Punt, referral to your best ortho/perio doc and watch!

I would agree with Richard ortho consult and get everything straight before stepping into the implant. if he says no on the ortho then consider a single implant with a cantilever pontic as I dont think you have sufficient space for two implants there.

Ortho, pt may not haven been made aware of this option? Otherwise fixed bridge is an easier and safer way to fix this problem. Implant wiil not look as good as the flipper and could end up to be a lot worse.

I agree with the above posters who are recommending an orthodontic consult. Any implant placed into a mouth with such an unfavorable anterior occlusion is doomed to failure from the get-go. I also agree that a fixed bridge will most likely be the best prosthetic treatment for this patient. The CBCT section that you included indicates that there is a loss of both vertical as well as horizontal bone. A block graft would most likely have to be done and possibly one or two follow up hard and or soft tissue augmentation procedures. If you restore this case with a fixed bridge, given this patient's HIGH line, you could manage the ridge defects with some type of ridge lap pontics and very possibly avoid one or several ridge augmentation procedures. DrT

I agrred with everybody but, the bridge is a good option, take in considaration that canine looks in normal oclussion and #9 in crossbite the bridge is going to look bad too. So start with ortho, perio and then fixed bridge or implant. Good luck. Dr LER