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報告者：傅超俊
報告日期：2012/05/15
Introduction

a high incidence of discrepancies in
gingival margin levels between an
implant crown and the contralateral
natural tooth.
Gotfredsen K.2004; Henriksson H,2004
 a lack of hard and soft tissue

To achieve favorable esthetic results by
regenerating hard and soft tissues
 surgical procedures to preserve or to
reconstruct hard and soft tissues
○ outcome is not always predictable.
 orthodontic forced eruption (OFE) or
orthodontic implant site development (OISD),
a technique described by Salama H and
Salama M(1993).
Aim
to evaluate the soft and hard tissue
response to OISD,
 to evaluate the clinical indications for
different degrees of periodontal
attachment loss on the extruded tooth
 to evaluate the implant survival rate in
areas where OISD was performed

Material and Method

From March 2004 until December 2009

A total of 32 teeth in 13 patients; 27
were replaced by implants and 5 were
replaced by pontics
Treatment course
Defect diagnosis
 Periodontal treatment, root canal therapy,
OFE,
 Tooth extraction, flapless immediate implant
placement with immediate provisionalization,
 Tissue conditioning with new provisional
prostheses for at least 6 months
 Delivery of the definitive restoration

Periapical radiographs and all
measurements
Before periodontal treatment (T-0) ;
 2 months after periodontal treatment, at
the beginning of orthodontic treatment
(T-1)
 During orthodontic treatment at 1-month
intervals (T-n)
 On the day of extraction and implant
insertion (T-end)
 At 6-month intervals

Periodontal treament

pocket depths 1 ~ 5 mm
 scaling and root planing in combination with
topical antibacterial treatment
(chlorhexidine0.1% rinse three times daily)

pockets >5 mm
 scaling and root planing in combination with
topical antibacterial treatment;
 1 month later : open flap debridement (modified
Widman flap) in combination with topical
antibacterial treatment (chlorhexidine0.2% three
times daily for 2 weeks).
Orthodontic treatment

1 mm of extrusion per month
 Light (15 to 50 g) continuous forces
 4- to 5-week rest period between activations

Buccal root torque component
 To increase the buccolingual bulk of alveolar
bone
The goal was to exceed by at least 2 mm
the bone level of the contralateral tooth
 2-month period of stabilization to allow
mineralization of the new trabeculae

Extaction and implant



Two days before implant placement, a final,
rapid extrusive force was applied to the
extruded tooth/teeth
All teeth were extracted without raising a flap
When a gap was present between the implant
and the alveolar bone plate
 Autologous bone chips or nonresorbable bone
substitute particles (Bio-Oss, Geistlich Pharma) were
placed to provide a solid scaffold for blood clot
formation.
 No flap was raised and no attempt was made to
achieve primary closure with sutures
Result
Data Analysis

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OE : Amount of orthodontic extrusion
BA : Amount of bone augmentation per extruded tooth
KGA : Amount of keratinized gingiva augmentation (vertical
augmentation of the keratinized width)
MGJM : Movement of the MGJ
GA : Amount of gingival augmentation per extruded tooth (coronal
movement of the gingival margin)
R : Amount of recession occurred during orthodontic treatment
GTA : Changes in gingival thickness on the facial side
PDR : Pocket depth reduction during orthodontic extrusion
PDT2 : pocket depth at the end of orthodontic extrusion
PDT1 : pocket depth at the beginning of orthodontic extrusion (2
months after periodontal treatment)
BA/OE % : Efficacy of the orthodontic vertical movement in creating
new bone (bone augmentation/ amount of orthodontic movement ratio;)
GA/OE % : Efficacy of the orthodontic vertical movement in creating
new soft tissue, (gingival augmentation/ amount of orthodontic
movement ratio;)
Changes in papillae height

The implant survival rate was 96.3%
(1 of 27 implants failed).
 during a follow-up period ranging from 18 to
61 months,
Discussion--Hard Tissue Changes

Bone formation/vertical movement ratio
was about 70%
 the vertical orthodontic tooth movement did not
convert completely into new bone.
 tooth having to erupt out of the pocket

No statistically significant differences in
the amount of BA/OE in the four
subgroups
 it is possible to regenerate bone by erupting
teeth that have lost more than 90% of the
surrounding bone
Soft Tissue Changes (1)

gingival growth
 GA/OE% was around 65% but variability
was more than bone

Three different clinical scenarios
 Gingival migration was proportional to the
orthodontic movement
 Gingival overgrowth was observed
 very little gingival growth was observed
Soft Tissue Changes (2)

Behavior of the gingival margin on
adjacent teeth---”blanket effect”
 When pulled up from two corners, moves
not only at the corners but at the center as
well, albeit to a lesser extent
Soft Tissue Changes (3)

Changes in the position of the MGJ--four possible clinical
 The MGJ does not move coronally but the
gingival margin does
 The MGJ moves coronally together with the
gingival margin,.
 Neither the MGJ nor the gingival margin
move coronally,.
 The MGJ moves coronally, while the gingival
margin does not
Soft Tissue Changes (4)

Biotype conversion

The thickness of the gingiva on the
buccal side .
 An increase in thickness was a consistent
finding
Advantages of OFE/OISD

Nonsurgical means

To rebuild both the hard and soft tissues
and insert an implant without ever
raising a flap

to overbuild the site to compensate for
postextraction remodeling
Conclusion
Bone augmentation/orthodontic
extrusion was about 70% and gingival
augmentation/orthodontic extrusion was
about 65%.
 Residual attachment level was not a
limitation to the amount of regenerated
bone.
 The implant survival rate was 96%.
