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Kwang Man Park
, Richard Leesungbok, Suk Won Lee
, Richard Leesungbok, Suk Won Lee
Abstract
Orthognathic surgery of skeletal Class III malocclusion improves oral function and facial appearance. The greater amount of skeletal discrepancy, the greater amount of teeth movement required for decompensation, and this often causes pathological changes in periodontal tissue especially in lower anterior dentition. We made a Top-Down treatment plan with personalized analysis using Face Hunter, Plane System and ARCUS Digma II, in order to resolve severe mobility and cross-bite of lower anterior teeth for 49-year-old female patient who had undergone orthognathic surgery 20 years ago due to skeletal Class III malocclusion and mandibular prognathism. Lower anterior teeth were extracted and alveoloplasty was done. After healing of the wound, immediate loading was conducted immediately after implant placement. Final restorations were fabricated Zirconia using CAD/CAM, and inserted intraorally screw-retained type. During 6-month follow-up, no abnormal episodes of restorations were observed, and obtained satisfactorily both of functional and esthetic outcomes.
Figures and Tables
Fig. 1
Initial intraoral view. (A) Occlusal view of upper dentition, (B) Occlusal view of lower dentition, (C) Right lateral view, (D) Left lateral view, (E) Frontal view of habitual bite, (F) Frontal view of CR bite, (G) Lateral view of habitual bite, (H) Lateral view of CR bite.
Fig. 2
Willis method. Measurements on the facial profile view of preoperative stage (A≒B), (A) Distance from the center of the pupil of the eye to rima oris, (B) Distance from bony ledge under the nose to the bottom of the mandible.
Fig. 3
Radiographic records. (A) Panoramic view before extraction of hopeless teeth (06-30-2016), (B) Panoramic view after placement of implant on #45 (06-05-2018), (C) Periapical view after placement of implant on #45 (06-05-2018), (D) After orthognathic surgery on 01-05-2010, (E) Before implant treatment on 06-22-2018.
Fig. 4
Extraction of the hopeless teeth. (A) Alveoloplasty after extraction of the lower anterior hopeless teeth on #44, #43, #42, #41, #31, #32, #33, and #34, (B) Delivery of removable temporary denture after suturing.
Fig. 5
Diagnostic wax-up on the mounted models. (A) Diagnostic wax-up on the lower anterior teeth, (B, C) Surgical template and immediate provisional restoration.
Fig. 6
The 1st implant surgery. (A) Implant placed on #33, #34, #43 and tooth extraction of #35, (B) Insertion of immediate provisional restoration on the implants.
Fig. 7
The 2nd implant surgery. (A, B) Implant remove due to failure on #33, and newly placed on #32,#35, (C, D) Final impression taking, (E) Adjusted immediate provisional restoration.
Fig. 8
Facial analysis and design with digital workflow. (A – C) CAD by Face Hunter & Plane System, (D) Arcus digma II data.
Fig. 9
Delivery of the polymer trial restoration. (A) The 1st CAD/CAM for fabrication of polymer trial restoration, (B) Frontal view after insertion.
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