When patients present with a tooth requiring extraction or an existing edentulous space, and they desire an implant, there are often site-related issues that challenge our ability to deliver ideal outcomes. This month's cover story examines some of the benefits of combining orthodontic treatment with implant dentistry to improve functional and esthetic outcomes in complex cases. Beyond using orthodontics to idealize the space for implant placement, the orthodontic forced eruption of a hopeless tooth prior to its extraction can increase the volume of hard and soft tissue at the site for future implant placement. To this end, Dennis Tarnow, DDS, would say that "a hopeless tooth isn't a useless tooth." An adjacent tooth can even be orthodontically moved into a deficient edentulous space to improve the tissues and then moved back to its correct position.
For combined orthodontic and implant treatment, the first hurdle is educating patients and determining its feasibility for them. I always say that placing implants requires bone and money. We can grow the bone, but we can't grow the money. The second hurdle is maintaining the level of interdisciplinary communication necessary to properly execute a combined orthodontic and implant treatment plan. Restoratively driven treatment planning necessitates proactive rather than reactive communication to achieve the best outcomes, so the restorative dentist should be initiating and properly managing all phases of treatment. As Stephen Dadaian, DDS, mentions in the article, sometimes an orthodontist believes that enough space has been opened up for an implant, but the roots of the adjacent teeth haven't been sufficiently torqued to allow it to be properly positioned. This happens a lot. Relatedly, the orthodontist may fail to create sufficient space if the desired implant size isn't communicated in advance by the implant dentist. The more complex the treatment plan, the more moving parts there are to coordinate. In order to minimize the overall time and cost while maximizing patient satisfaction, each phase must be optimized. Patients who have been told that they are finished with orthodontics don't want to find out that they need more. Don't pursue the ideal and end up with less than ideal. If patients are willing to go through the rigors of complex treatment, you have to achieve the results that they want.
Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor • Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@conexiant.com
