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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 30-31

Implant prosthetics planning in anterior maxillary defects in deep bite cases


1 Department of Prosthodontics, Dr. B. R. Ambedkar Dental College, Patna, Bihar, India
2 Consultant Prosthodontist and Implantologist, Agartala, Tripura, India
3 Department of Prosthodontics, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, India
4 Department of Prosthodontics, Subbaiah College of Dental Science, Shimoga, Karnataka, India
5 Consultant Periodontist and Implantologist, Patna, Bihar, India
6 Consultant Orthodontist, Patna, Bihar, India

Date of Submission28-Jan-2021
Date of Acceptance10-Feb-2021
Date of Web Publication29-Mar-2021

Correspondence Address:
Dr. Desh Deepak
Department of Prosthodontics, Dr. B. R. Ambedkar Dental College, Patna, Bihar.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_6_21

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  Abstract 

Modern implant dentistry has been shown to yield excellent, well-documented, long-term results, with 10-year success and survival rates above 95%. Dentists now have the choice of using an array of preoperative planning tools, both conventional and computer-aided, to help them assess potential rehabilitative treatment solutions for their patients with implant prosthetics planning in anterior maxillary defects in deep bite cases.

Keywords: Anterior maxillary defects, deep bite, implant dentistry


How to cite this article:
Deepak D, Bhattacharya D, Gandhi P, Patil H, Mishra K, Kumar K. Implant prosthetics planning in anterior maxillary defects in deep bite cases. Int J Oral Care Res 2021;9:30-1

How to cite this URL:
Deepak D, Bhattacharya D, Gandhi P, Patil H, Mishra K, Kumar K. Implant prosthetics planning in anterior maxillary defects in deep bite cases. Int J Oral Care Res [serial online] 2021 [cited 2021 Apr 13];9:30-1. Available from: https://www.ijocr.org/text.asp?2021/9/1/30/312536




  Introduction Top


A deep overbite is a vertical overlap of the upper and lower incisors that exceed half of the lower incisal tooth height. Problems related to deep overbite include soft tissue trauma, a lack of inter-occlusal space, and tooth wear.[1],[2],[3] Most cases of dentoalveolar traumata occur in the maxillary incisor area. Most are complicated crown fractures and some root fractures. However, in patients with severe deep overbite with dentofacial deformities in which the positional relationship between the upper and lower jaws has vertical or horizontal incongruity, it is difficult to recover functions with ordinary prosthetic therapy alone. Such cases require occlusal reconstruction using a combination of different prosthetic treatments. Severe deep overbite is one of the most common malocclusions in orthodontic practice. Indeed, when defined as overbite ≥5 mm, the condition is found in nearly 20% of children and 13% of adults and accounts for about 95.2% of the vertical occlusal problems. It is widely accepted that prosthodontic treatment along with orthodontic treatment of severe deep overbite is both easier to accomplish and more stable when performed on growing patients than when performed on adults with bone anterior maxillary defects.[4],[5],[6] For this reason, adults often avoid orthodontic treatment and settle for simple correction of excessive overbite. For patients who do not complain about facial aesthetics, camouflage therapy—in which skeletal problems are masked by rearranging the dentoalveolar structure—can be offered.


  Implant Prosthetics Planning in Anterior Maxillary Defects in Deep Bite Cases Top


The number of cases in which implants are selected as a prosthetic treatment for missing teeth will increase as implant treatment becomes more widespread. On the other hand, in implant treatment for patients with dentofacial deformities, it is necessary to consider the order and timing of the treatment on a case-by-case basis. The malocclusion and jaw function abnormalities associated with dentofacial deformities can be considered to be risk factors related to occlusion and to the collapse of occlusion along with factors such as dental caries/periodontal disease and aging. Therefore, in cases with multiple tooth loss and dentofacial deformity, a comprehensive dental treatment incorporating orthognathic surgery should be considered as an option, not only for prosthodontic treatment of the anterior maxillary defect but also to obtain a stable occlusion in the long run.[7],[8],[9],[10] Aesthetics and functional demands in the restoring of anterior maxillary area have always been a major factor of choosing the treatment option available. Endosseous implant success required full coverage of implant surface with bone. Augmentation of local defect of alveolar ridge with bone grafts enables to achieve these prerequisite in insufficient bone volume. Different surgical procedure available to create enough bone volume such as autogenous bone graft includes only graft, interpositional bone graft, guided bone regeneration, and combination of these procedures. Estimating the degree of bone defect is not easy. Because the mucosal contour can mask the actual dimension of the alveolar ridge, ridge mapping, cone-beam computerized tomography, and dental scan can be used. Endosseous dental implants are a predictable modality of tooth replacement that can improve dental health and quality of life for many people. Different studies have reported that the success and survival rate of dental implant placed in anterior maxilla are almost same to other segments of the jaw. However, there is often inadequate bone to receive and support implants. This can be the result of trauma, periodontal disease, endodontic infection, post-extraction ridge defects, disuse atrophy, etc.[11],[12] Successful implant placement in planed site required enough bone volume of sufficient density to enable an implant of the appropriate size to be placed in a desirable position and orientation. Placement of bone grafts in conjunction with endosseous dental implant shortens the treatment time without influencing the success rate or increases the complication. The degree of bone grafting required for implant placement varies from localized deficiencies to cases where there is a need to change the entire arch form and/or jaw relationship. Another prerequesting of this case to achieve an optimal result is soft tissue management. Successful dental implant restoration in issue framing esthetic zone required a healthy and correctly contoured soft tissue framing, which is defined as the gingival contour that surrounds the prosthesis. Achieving aesthetics interdental papilla which fills the space between teeth or implants required an interproximal bone crest of 5 mm of an estimated contact point in planned restoration. Three-dimensional position of the implant is required to achieve an optimal emergence profile. Mesio-distally positioning of implant required 1.5 mm space between implant and adjacent teeth or between implant/implant. Labio-palatel positioning is also important, too far labially results in overcontouring of the crown and can cause recession due to a decrease in the thickness of buccal bone. On the other hand, if there is coronal placement, esthetics may be compromised due to visibility of the implant shoulder.[1-5],[12-14] The implant should be placed 1.5 mm to 3.0 mm below the cementoenamel junction for optimal implant esthetics. Tissue training helps to develop a proper emergence profile and natural tooth appearance, and also helps in re-establishing normal gingival tissue contours and interdental papillae. Fabricating provisional restoration before inserting the final prosthesis will improve esthetics. Alveolar bone loss can occur after tooth extraction or trauma. Furthermore, it can be complicated by the traumatic deep bite that leads to severe alveolar ridge resorption. Atrophy of the alveolar bone may also be seen in congenitally missing teeth, failed implants, and advanced periodontal disease.


  Conclusion Top


This report describes that the implant prosthetics planning in anterior maxillary defects in deep bite cases to lower risk of complete bone fracture, better maintain soft and hard tissue volume, and enhance the emergence profile of the prosthesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Beddis HP, Durey K, Alhilou A, Chan MF The restorative management of the deep overbite. Br Dent J 2014;217:509-15.  Back to cited text no. 1
    
2.
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3.
Keim RG Fine-tuning our treatment of deep bites. J Clin Orthod 2008;42:687-8.  Back to cited text no. 3
    
4.
El-Dawlatly MM, Fayed MMS, Heider AM, Mostafa YA Deep bite: A treatment planning decision support scheme. Dent Oral Craniofac Res 2015;1:81-9.  Back to cited text no. 4
    
5.
Büyükbayraktar Z, Doruk C, Camcı H Camouflage treatment of a severe deep-bite and orthognathic surgery required case with en masse retraction. Turk J Orthod 2017;30:126-31.  Back to cited text no. 5
    
6.
Daokar S, Agrawal G Deep bite its etiology, diagnosis and management: A review. J Orthod Endod 2016;2:1-4.  Back to cited text no. 6
    
7.
Renato P, Ribeiro C Angle Class II, Division 2, malocclusion with deep overbite. Dent Press J Orthod 2010;15:132-43.  Back to cited text no. 7
    
8.
Shilya PND, Gowda S, Manohar MR Management of skeletal class II, deep bite. APOS Trends Orthod 2014;4:191-5.  Back to cited text no. 8
    
9.
McDonagh S, Chadwick JC The combined orthodontic and surgical treatment of traumatic Class II division 2 in the adult. Dent Update 2004;31:83-88, 90-81.  Back to cited text no. 9
    
10.
Shimo T, Yoshioka TN, Nakamura M, Ibaragi S, Okui T, et al. Orthognathic surgery during breast cancer treatment–a case report. Int J Surg Case Rep2017;31:30-4.  Back to cited text no. 10
    
11.
Wragg PF, Jenkins WM, Watson IB, Stirrups DR The deep overbite: Prevention of trauma. Br Dent J 1990;168:365-7.  Back to cited text no. 11
    
12.
Cotter S, O’Shea D Traumatic overbite: A restorative solution. Dent Update 2002;29:136-40.  Back to cited text no. 12
    
13.
Yoshitake N, Sumi K, Kondo S, Aijima R, Danjo A. A case of mandibular prognathism without molar support treated by comprehensive dental therapy. Jpn J Jaw Deform 2018;28: 34-41.  Back to cited text no. 13
    
14.
Kim YK Complications associated with orthognathic surgery. J Korean Assoc Oral Maxillofac Surg 2017;43:3-15.  Back to cited text no. 14
    




 

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