Hello EVeryone,

It is a great pleasure to see many more posts involving 'ortho' as an intregal component to the tx. planning process. I want to introduce another aspect of orthodontic tooth movement, which I hope will garner more traction in the future…"Orthodontically Induced Bone Generation". I would like to share another case, which continues to amaze me, how the body responds to favourable forces. Now, for some case history: female patient, 48 years, recently failed (2nd time) Maryland bridge replacing lower, right lateral incisor (FDI 4.2, Universal #26), lack of bone for implant, requests single tooth dentistry and avoid another bridge. I offerred an alternate tx. option of orthodontically moving the central incisor(4.1, #25) into the lateral site and placing an implant in the newly created edentulous site in the central location. I was exposed to this procedure at a previous SPEAR Summit from a few years ago. The ortho tx. took longer than I had anticipated (I was on the learning curve of providing challenging dentistry). The ortho tx. was completed in 2017. Now comes the most interesting aspects of the case. Bewteen 2018 and 2023, the patient fell off the radar, COVID-19 appeared and I retired. In the spring of 2023, the patient returned to the practice and I was able to obtain some records. It was amazing how stable the hard and soft tissues remained, in 3 dimensions, over this time.

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The photos cover the period Dec'14 - Oct'15 - Nov'18 - Apr'23.

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The radiographs cover the period from Oct'14 - Jan'17 - June'18 - Aug'18 - Apr'23. Prior to the patient dissappearing, she was referred for an endodontic assessment of the central incisor. The most recent pA indicates it has not received any tx. One of the challenges of no longer being actively involved in the clinic and patient care, some of these cases are left without a quarterback. The patient has now requested the area be restored,with the present clinician, using an implant. Knowing what I know today, thanks to my exposure of options via SPEAR Education, my recommended treatment of choice would have been a bonded, single wing Maryland Bridge. Very recently, she has received an implant.

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Now comes the amazing part: the volume of 3 - dimensional bone present when the flap was raised. The surgeon advised me no grafting, hard or soft tissue, was necessary and the bone quality was very good. In my opinion, too much bone was present in the vertical dimension. To provide an aesthetically, pleasing emergence profile of the implant crown, some bone should have been removed to seat the fixture deeper into the bone.

Today, after refining my technique and if I was still in practice, this procedure in the lower anterior can be accomplished in approximately 9 months. In the premolar area, it will probably take 12 months. During the last 2 years of clinical practice, 6 patients received this teatment, all with 100% successfull ortho induced bone generation. It has been shown to be very predictable and what the patients enjoyed the most…a pain-free experience.

Richard.