Replacing Missing Laterals:

presented by

Ron Jackson, DDS, FACD, FAGD, FAACD

to benefit

In conjunction with

January 25, 2018

2/4/2018

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Friday Factoids – July 28, 2017www.fauquiernow.com

• Fiscal Year ending June 30, 2017 – 3,164 dental patient visits

• Represents 24% increase from previous year (2,550 visits)

• 1,269 patients seen from Fauquier & Rappahannock counties a 10.7% increase from previous year

• Clinic spent - $285,300 on dental care up 8% from 2016

• Autosomal dominant trait

• Occurs in over 4% of the population

• Females to males 2:1

• 2/3 have both missing upper laterals

• 1/2 of those with only one missing –contralateral tooth is deficient or peg

• Canine Substitution

• Removable Partial Denture (Flipper)

• Conventional 3 Unit Bridge

• Maryland Bridge

• Implant

• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)

• Canine Substitution

1) Size

2) Shape

3) Color

4) Gingival crest height

5) Function

2011

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2013

20132011

Line Angle

Reduce & round lingual cusp

• Canine Substitution

• Removable Partial Denture (Flipper)

• Conventional 3 Unit Bridge

• Maryland Bridge

• Implant

• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)

• Canine Substitution

• Removable Partial Denture (Flipper)

• Conventional 3 Unit Bridge

• Maryland Bridge

• Implant

• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)

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• Canine Substitution

• Removable Partial Denture (Flipper)

• Conventional 3 Unit Bridge

• Maryland Bridge

• Implant

• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)

• Canine Substitution

• Removable Partial Denture (Flipper)

• Conventional 3 Unit Bridge

• Maryland Bridge

• Implant

• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)

- XXXX, General DentistGen Dent, September/October 2008; 56 (6):516-519

Replacement of Congenitally Missing Incisors with Implant Crowns

“Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for Younger Patients.”

- XXXX, PeriodontistDental Products Report February 2008; 34-36

Implants at any Age

“… it’s still unclear at what age implants can be placed -….This article presents clinical evidence that implants can be successfully placed in patients younger than 18.”

Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7

“maxillary lateral incisor implants are challenging esthetically.the amount of space is often small,the papillae are occasionally short,the adjacent roots could be too close,

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Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7

“maxillary lateral incisor implants are challenging esthetically.the amount of space is often small,the papillae are occasionally short,the adjacent roots could be too close, the gingival levels may be uneven, and the patient could be too young.”

1) Lekholm U. The Use of Osseointegrated implants in growing jaws.Int. J Oral Maxillofac Implants 1993;8:243-244.

2) Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients – case report. Int. J Periodont Restor Dent 1996;16:421-433.

3) Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up StudyEuropean Journal of Orthodontics 23 (2001), #6 pp 715-731

4) Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement.Int J Oral Maxillofac Implants 2006; 21: 867-878

Articles about the use of implants in adolescents:

1) Lekholm U. The Use of Osseointegrated implants in growing jaws.Int. J Oral Maxillofac Implants 1993;8:243-244.

2) Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following placement of single-tooth implants in young patients – case report. Int. J Periodont Restor Dent 1996;16:421-433.

3) Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents: A 10-year Follow up StudyEuropean Journal of Orthodontics 23 (2001), #6 pp 715-731

4) Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial Drift as Compromising Factors for Implant Placement.Int J Oral Maxillofac Implants 2006; 21: 867-878

Articles about the use of implants in adolescents:

Facial Development, Continuous Tooth Eruptionand Mesial Drift as Compromising Factors for

Implant Placement

“….. jaw growth may compromise theoutcome of oral rehabilitation using implant-supported prostheses even if the implants aresuccessfully integrated.”

“It should be noted that the age at which growth is complete varies widely.”

- Heij DG, Opdebeeck H, et.alIn J Oral Maxillofac Implants 2006; 21: 867-878

Orthodontic Aspects of the Use of Oral ImplantsIn Adolescents: A 10-year Follow up Study;Thilander B, Odmon J, Lekholm U, European Journal of Orthodontics 23(2001), #6pp 715-731

Implant in lateral position 15 year old male

Age 18 1.6mm infraocclusion

Age 252.2mm infraocclusion

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“ The best method of evaluating the completion of facial growth is by superimposing sequential cephalometricradiographs taken at least one yearapart…..

Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7

The AVERAGE age at which facial growth stops in girls is about 17 years

and in boys it is about 21 years of age.”

?????????

Face Height and Tooth Eruption in Adults –a 20-year Follow-up Investigation

- Forsberg CM, Eliasson S, Westergren HEuro J Ortho 1991 13(4): 249-254

• 15 men and 15 women ages 25-45 yrs.

• Significant changes in anterior facial height

• Dentoalveolar change indicative of continued eruption and vertical growth of the surrounding tissues.

1) Bernard JP, Schatz JP. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. J Clin Periodont 2004;31(11):1024 – 1028.

2) Oesterle LJ, Cronin RJ. Adult Growth, Aging and the Single-Tooth Implant.Int J Oral maxillofac Implants 2000; 15: 252-260.

3) Tarlow JL. The Effect of Adult Growth on an Anterior Maxillary Single-Tooth Implant: A Clinical Report.J Prosthet Dent 2004; 92: 213-215.

4) Zachrisson BU. Single implant supported crowns in the anterior maxilla – potential esthetic long-term (> 5 years) problems. World J of Orhto 2006; 7: 306-312.

5) Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants.Int J Oral Maxillofac Impl 2012; 28:163-169

6) Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation.Gen Dent July/Aug 2017; 7-11

Articles about the use of implants in adults:

3-dimensional craniofacial skeletal growth and remodeling are continuous throughout life

1) Bernard JP, Schatz JP. Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. J Clin Periodont 2004;31(11):1024 – 1028.

2) Oesterle LJ, Cronin RJ. Adult Growth, Aging and the Single-Tooth Implant.Int J Oral maxillofac Implants 2000; 15: 252-260.

3) Tarlow JL. The Effect of Adult Growth on an Anterior Maxillary Single-Tooth Implant: A Clinical Report.J Prosthet Dent 2004; 92: 213-215.

4) Zachrisson BU. Single implant supported crowns in the anterior maxilla – potential esthetic long-term (> 5 years) problems. World J of Orhto 2006; 7: 306-312.

5) Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated Implants.Int J Oral Maxillofac Impl 2012; 28:163-169

6) Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch Maturation.Gen Dent July/Aug 2017; 7-11

Articles about the use of implants in adults:

3-dimensional craniofacial skeletal growth and remodeling are continuous throughout life

Long-term vertical changes of the anterior maxillary teethadjacent to single implants in young and mature adults:

A Retrospective Study-Bernard JP, Schatz JP, Christou P, et.alJ Clin Periodontol 2004; 31: 1024-1028

14 Young Adults (Ages 15 – 21)

.1 – 1.65mm implant infraocclusionover 1-9 years

14 Mature Adults (Ages 40 – 55)

.1 – 1.86mm implant infraocclusionover 1-9 years

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Conclusions:

1) Some vertical changes small over 9 yearsSome vertical changes significant over 1year

Highly variable2) Mature adults can exhibit major vertical steps

after anterior restorations with osseointegrated fixtures to the same extent as adolescents or “young adult” individuals with residual growth potential.

Adult Growth, Aging and the Single-Tooth Implant

- Oesterle LJ, Cronin RJInt J Oral Maxillofac Implants 2000; 15: 252-260

“While the average changes are small, apatient demonstrating maximum growth mayshow 2 to 3mm of vertical increase in the natural teeth …..”

Implant Crown #9 Female - Age 24

Age 29

2mm

Implant Crown #9 Female - Age 24

Age 29

2mm

Cases Courtesy of:Dr. Sverker Toreskog

Implant Crown #815 year post op

(placed Age 20)

Inside Dentistry, Oct. 2008, pp. 82 – 87

Courtesy Drs. Coachman, Garber, Salama

Age 33Implant Crown

10 years post op

Age 23Implant Crown #9

Try-in New implant Crown

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Zirconia Abutment with Pink Composite

Immediate Post-op new crown

Cleaning new implant crown

Age 28

Age 382mm short

Tarlow Jeffrey, J Prosthet Dent, September 2004;92:213 – 215.

At insertion .5mm short

1.5mm change

Female Age 22 internal resorption #8

General DentistryJuly 2013

- Zachrisson BUWorld J Ortho 2006; 7: 306 - 312

Implant-supported Crowns in the Esthetic Zone:Long-term effects

1. Darkening (“blue-coloring) of the overlying labial gingiva

2. Progressive infraocclusion of the crown (even in mature Adults)

3. Gingival retraction and “root” exposure

Single Implant-supported Crowns in the anterior maxilla – potential esthetic long-term

(>5 years) problems- Zachrisson BUWorld J Ortho 2006; 7: 306 - 312

“…the fact that the space for a missing incisorcan now be substituted with an implant-supported crown does not necessarily imply that this replacement fulfills optimal esthetic requirements, and that this technique is superior to other treatmentoptions in a lifelong perspective for the patient.”

- XXXX, General DentistGen Dent, September/October 2008; 56 (6):516-519

Replacement of Congenitally Missing Incisors with Implant Crowns

“Implant placement and restoration is a preferred solution for the replacement of missing teeth in any age group but is particularly beneficial for Younger Patients.”

- XXXX, PeriodontistDental Products Report February 2008; 34-36

Implants at any Age

“… it’s still unclear at what age implants can be placed -…. This article presents clinical evidence that implants can be successfully placed in patients younger than 18.”

2/4/2018

8

• Canine Substitution

• Removable Partial Denture (Flipper)

• Conventional 3 Unit Bridge

• Maryland Bridge

• Implant

• Fiber reinforced Composite Inlay Bridge (FRC Inlay Bridge)

“ If patients are immature at the end of orthodontics and will have significant facial growth,

Vincent Kokich, DDSAdvanced Esthetics & Interdisciplinary DentistryVol. 2, No. 2, 2006 pp. 2 - 7

it may be appropriate to place a bonded rather than a removable retainer in order to prevent reapproximation of the central incisor and canine roots.”

15 year old

19 year old

19 year old Female

19 year old Female

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19 year old Female

D1 D2D1

.75~D2

19 year old Female

D1 D2D1

.75~D2

Shallow Overbite

NormalOverbite

DeepOverbite

Shallow Overbite

NormalOverbite

DeepOverbite

Shallow Overbite

NormalOverbite

DeepOverbite

Excess Horizontal Overjet .5 - .7mm

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Shallow Overbite

NormalOverbite

DeepOverbite

Excess Horizontal Overjet .5 - .7mm

- Shallow Overbite- .5mm excess Horizontal Overjet

- Shallow Overbite- .5mm excess Horizontal Overjet.5mm

depth

.75mm Inlay prep

.75mmdepth

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7.39 / 9.04 = 82% 6.58 / 9.04 = 72%

7.39 / 9.04 = 82% 6.58 / 9.04 = 72%

Reduce space by¾ mm

A1

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A1

1. 2-step Self-etch 1-step Self -etch

2. Remove air inhibited layer with alcohol pledget

OR

Universal

Apply scrubbing20 seconds & dry

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Apply scrubbing15 seconds & dry

Apply scrubbing15 seconds & dry

Apply scrubbing20 seconds & dryApply scrubbing15 seconds & dry

Remove Air Inhibited layerWith Alcohol Pledget

Try-in

Mock up

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Mock up

Ivoclar Bisco

OR

Optidisc (Kerr)

Optidisc (Kerr)

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Optidisc (Kerr)

Optidisc (Kerr)

Optidisc (Kerr)

3 month post op

17 Year old Male

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17 Year old Male

17 Year old Male

- 2.5mm - 1.5mm

Add to gingival surfaces of denture teeth

to maintain pontic sites

Add to gingival surfaces of denture teeth

to maintain pontic sites

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Add to gingival surfaces of denture teeth

to maintain pontic sites

A1

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Ultradent (800-552-5512)

Star Brush

2% Chlorhexidine

Ultradent

888-822-4890 www.cognident.com

Adhesive applied, dried, cured

Other Choices:RelyX Veneer (3M/Espe)

Choice 2 (Bisco)

Nexus 2 (Kerr)

Flowable Resin

Other Choices:RelyX Veneer (3M/Espe)

Choice 2 (Bisco)

Nexus 2 (Kerr)

Flowable Resin

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Other Choices:RelyX Veneer (3M/Espe)

Choice 2 (Bisco)

Nexus 2 (Kerr)

Flowable Resin

6 month Post Op

20 year old female

20 year old female

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Suck-down matrixon preop model

Suck-down matrixon preop model

Suck-down matrixon preop model

Suck-down matrixon preop model

Suck-down matrixon preop model

Uncured Compositein matrix

Seat Matrix and Cure

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Fill preps with Flowable and cure

17 Year old Male

5 years post op

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17 Year OldDirect Resin Veneer

at 4 years

5 years post op

17 year old female

D2D1

.95~D2 D1

17 year old female

D2D1

.95~

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17 year old female

D2D1

.95~

17 year old female

D2D1

.95~

• Not Desired by the Patient

• Restoratively Contraindicated

40 year old

12 years post op

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Fractures

Ceramic Veneer Retained Bridge

Bonded Porcelain Restorations in the Anterior Dentition:A Biomimetic Approach; Magne P, Belser U. Quintessence 2002

1 year post op

20 year post op: Implant #7 placed at age 19

1mm3mm

20 year post op: Implant #7 placed at age 19

1mm3mm

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20 years

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LongevitySuccess Rate varies widely :

54% failure rate over 11 months

to

90% success rate over 11 years

Technique Dependent

Long-term Clinical Performance of Resin-bonded Fixed Partial Dentures with Retentive

Preparation Geometry in Anterior and Posterior Areas

-Aggstaller H, Beuer F, et.al.J Adhes Dent 2008; 10: 301-306

Retentive preparation design –88% survival at 10 years

Average Survival - 16 years

Longevity of fiber-reinforced composite fixed partial dentures (FRCFPD) – Systematic review

- Ahmed KE, Li KY, Murray CAJ Dent 2017; 61: 1-11

Survival – 94.5% at 4.8 years

Retentive tooth preparations performedbetter than retainers without a preparation

Conclusion:

FRC FPDs demonstrated high overall survival with predictable performance outcomes

FRC FPDs should no longer be considered as experimental, temporary or short term treatment modalities.

Quint Whipple, CDTAcknowledgment:

www.phoeniciandental.com888-888-6215

Alternative Bridge Designusing

Glass Ceramic (emax)

Fifteen-year Survival of Anterior All-Ceramic Cantilever Resin-Bonded Fixed Dental Prostheses.

Kern M. J Dent 2017; 56: 133-135

Barwacz, CAJERD 2014 Vol 26 No. 5 pp.314-323

emax (Ivoclar Vivadent)

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Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed dental prostheses and the influence of the reasons for missing incisors

- Kern M, Passia N, et. AlJ Dent 2017; 65: 51 - 55

Anterior zirconia ceramic cantilever RBFDPs provided excellent clinical longevity

Conclusion:

RESOURCES

The International Association of Physiologic Aesthetics (IAPA) 866-669-4222 or

www.theiapa.com

American Academy of Cosmetic Dentistry Annual Meeting (AACD) 800-543-9220 or

www.aacd.com

Photography Equipment:

• Washington Scientific Camera – 615 Wood Avenue Sumner, Washington 98390

253-863-2854 or wsccrz@aol.com

• Norman Camera - 3602 S. Westnedge Kalamazoo, Michigan 49008

800-900-6676 or www.normancamera.com

Photography/Software Courses:

• Dr. Greg Lutke – Dallas Dental Solutions Plano, Texas 866-801-9733 or

www.dental-solutions.com

Photo Mounts (to send photos to patients):

(UP#488 – “Your New Smile”) Ultradent Products, Inc. 800-552-5512 or www.ultradent.com

Reality and “Reality Now”

Esthetic Dentistry Research Group

www.realityesthetics.com

(800) 544 – 4999

Journal of Adhesive Dentistry

Quintessence Publishing Co., Inc.

www.quintpub.com

(630) 682 – 3223

SELECTED BIBLIOGRAPHY

1. Lekholm U. The Use of Osseointegrated implants in growing jaws.

Int. J Oral Maxillofac Implants 1993;8:243-244.

2. Westwood RM, Duncan JM. Implants in Adolescents: a literature review and case reports. Int.

J Oral Maxillofac Implants 1996;11:750-755.

3. Johansson G, Palmqvist S, Svenson B. Effects of early placement of a single tooth implant, A

case report. Clin Oral Implants Res 1994;5:48-51.

4. Brugnolo E, Mazzocco C, Cordioll G, Majzoub Z. Clinical and radiographic findings following

placement of single-tooth implants in young patients – case report. Int. J Periodont Restor

Dent 1996;16:421-433.

5. Thilander B, Odmon J, et.al. Orthodontic Aspects of the Use of Oral Implants In Adolescents:

A 10-year Follow up Study European Journal of Orthodontics 23 (2001), #6 pp 715-731

6. Heij DG, Opdebeeck H, et.al. Facial Development, Continuous Tooth Eruption and Mesial

Drift as Compromising Factors for Implant Placement.

Int J Oral Maxillofac Implants 2006; 21: 867-878

7. Forsberg CM, Eliasson S, Westergren H. Face Height and Tooth Eruption in Adults – a 20-

year Follow-up Investigation Euro J Ortho 1991 13(4): 249-254\

8. Bernard JP, Schatz JP, Christou P, Belser U, Kiliaridis S Long-term vertical changes of the

anterior maxillary teeth adjacent to single implants in young and mature adults: A

retrospective study, , J Clin Periodontol 2004 Nov; 31(11): 1024-8

9. Oesterle L, Cronin Jr. RJ, Adult growth, aging and the Single-tooth Implant, In

J Oral Maxillofac Implants 2000; 15: 252-260

10. Thilander B, Odman J, Lekholm U, Orthodontic aspects of the use of oral implants in

adolescents: a 10-year follow-up study, European J Ortho 23 (2001): 715-731

11. Tarlow J, The effect of adult growth on an anterior maxillary single-tooth implant: A clinical

report, J Prosthet Dent 2004; 92:213-5

12. Daftary F, et.al. Lifelong Craniofacial Growth and the Implications for Osseointegrated

Implants. Int J Oral Maxillofac Impl 2012; 28:163-169

13. Solow RA. Relative Displacement of Implant-supported crowns with Dental Arch

Maturation. Gen Dent July/Aug 2017; 7-11

14. Zachrisson BU Implant-supported Crowns in the Esthetic Zone:

Long-term effects, World J Ortho 2006; 7: 306 – 312

15. Zachrisson BU Single Implant-supported Crowns in the anterior maxilla – potential esthetic

long-term (>5 years) problems, World J Ortho 2006; 7: 306 – 312

16. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition:

A Biomimetic Approach; Quintessence 2002

17. Aggstaller H, Beuer F, et.al. Long-term Clinical Performance of Resin-bonded Fixed Partial

Dentures with Retentive Preparation Geometry in Anterior and Posterior Areas, J Adhes

Dent 2008; 10: 301-306

18. Ahmed KE, Li KY, Murray CA Longevity of fiber-reinforced composite fixed partial dentures

(FRCFPD) – Systematic review, J Dent 2017; 61: 1-11

19. Kern M., Fifteen-year Survival of Anterior All-Ceramic Cantilever Resin-Bonded Fixed

Dental Prostheses. J Dent 2017; 56: 133-135

20. Kern M., Passia N, et.al. Ten-year outcome of zirconia ceramic cantilever resin-bonded fixed

dental prostheses and the influence of the reasons for missing incisors, J Dent 2017; 65: 51 -

55

21. Papacchini F, Dall’Oca S, Chieffi N, et.al, Composite-to-Composite Microtensile Bond

Strength in the Repair of a Microfilled Hybrid Resin: Effect of Surfact Treatment and

Oxygen Inhibition, J Adhes Dent 2007; 9: 25-31

22. Dudney T, Advantages and Disadvantages of Treatment Options for Congentially Missing

Lateral Incisors, Inside Dentistry Sept. 2008 pp. 68-70