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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 9 (2007), No. 1     15. Mar. 2007

Int Poster J Dent Oral Med 2007, Vol 9 No 01, Poster 342

A Case Report: Orthodontic Treatment with Extraction and Dental Implant in an Adult Patient.

Language: English

Dr. Karl-Ludwig Mischke, Dr. Mark Dennis Weltermann, Univ.-Prof. Dr. Ulrike Ehmer
Department of Orthodontics, Westfälische Wilhelms-University Münster

PD Dr. Dr. Johannes Kleinheinz,
Department of Cranio-Maxillofacial Surgery, Westfälische Wilhelms-University Münster

127. Jahrestagung der Deutschen Gesellschaft für Zahn-, Mund- und Kieferheilkunde e.V.
Aachen, Germany


This case report shows an interdisciplinary treatment approach in a 27 years old Patient with upper midline deviation, crowding in lower jaw and need for restoration in regio 2.4-2.5 as chief compliant.

Material and Methods

Midline deflection in upper jaw, aplasia 2.4 & 2.5, severe crowding in mandible and buccal non-occlusion of 3.5. The patient had a removable interim denture. She decided to undergo a comprehensive orthodontics-implantology therapy which consisted of extraction of 3 premolars and a dental implant for 2.4 after an intense consultation.

Consultation at the Department of Orthodontics


  • maxilary midline deviation to the left
  • rotation of the upper incisors, 1.6 mesio-labially rotated
  • aplasia 2.4&2.5, space 5 mm
  • crowding in lower arch especially region 3.5
  • anterior open bite tendence (edge to edge)
  • moderate craniomandibular dysfunction (mild headache, pressure sensibility) and patient did not want to have splint

Treatment planning:

  • extraction 1.4, 3.5, 4.4
  • max. midline correction, derotation
  • increasing the overbite
  • creating space in regio 2.4 for the dental implant and crown (7 mm)
Fig 1.1: 26.8 year old patient Fig 1.2: Maxilary midline deviation to the left Fig 1.3 Fig 1.4
Fig 1.5 Fig 1.6 Fig 1.7: Prothesa for 2.4
Fig 1.8: Temporary acrylic restoration for 2.4 in situ Fig 1.9: Severe crowding regio 3.5
Fig 1.10: neutral growth pattern, shallow overbite, mild incisor proclination
Fig 1.11: situation with restorations completed, missing 2.4, 2.5

Indirect upper & lower fixed appliance

  • indirect bonding
  • 0.022'' slot
  • wire: Neosentalloy 0.014 light
Fig 2.1 Fig 2.2 Fig 2.3
Fig 2.4: situation after pre-therapeutic extractions Fig 2.5: situation after pre-therapeutic extractions

Levelling and Alligning

  • initial derotation of incicors
  • progressive derotation 1.6
Fig 3.1 Fig 3.2 Fig 3.3
Fig 3.4 Fig 3.5

Leading phase

  • 0.016/0.022 Stainless Steel upper and lower arch
  • figure eight ligature from 1.7-1.5
  • closed coil spring between 1.6-1.3
  • figure eight ligature between 1.2-2.1
  • Niti closed coil spring between 2.3-2.2 & 2.6-2.3
Fig 4.1 Fig 4.2: Beginning of the midline correction Fig 4.3
Fig 4.4: Derotation 1.1 and 2.1, Advanced derotation 1.6 Fig 4.5: lower anterior segment was formed

Interim result

  • reshaping of upper and lower anterior segment
  • closing spaces
  • correcting the midline deviation
  • obtaining 7 mm of space in region 2.4/2.5
Fig 5.1 Fig 5.2: Midline correction still incomplete Fig 5.3
Fig 5.4: Maxillary midline deviated to the right Space between 2.2-2.3 Fig 5.5: space closure continued
Fig 5.6

Finishing and debonding

  • derotation of upper and lower anterion segment
  • space was closed
  • midline deviation was corrected
  • retention of the 7 mm space regio 2.4/2.5
  • vacuum formend retainer (with pontic for 2.4) was fitted
Fig 6.1 Fig 6.2
Fig 6.3
Fig 6.4 Fig 6.5
Fig 6.6: normal overbite, slightly reclined incisors Fig 6.7: after debonding
Fig 6.8 Fig 6.9 Fig 6.10
Fig 6.11 Fig 6.12

Dental Implant

  • ITI-Implant for regio 2.4/2.5
  • Diameter : 4.1 mm
  • Length : 12 mm
Fig 7.1:dental Implant intraoperative Fig 7.2 Fig 7.3
Fig 7.4: dental film post-operative

End of treatment

  • crown for 2.4 in situ
  • bonded lingual canine-to-canine retainer for lower front teeth
Fig 8.1 Fig 8.2: Midline corrected Fig 8.3: Supra construction for 2.4 was fitted
Fig 8.4: Space closed Fig 8.5: Lingual retainer bonded to 6 teeth indirectly
Fig 8.6


The upper midline deviation was corrected in 21 months using a fixed appliance and space for the dental implant regio 2.4 was created. The crown was fitted 4 months after the insertion of the implant. Vacuum formed retainer with occlusal adjustment in upper jaw and bonded lingual retainer in lower jaw were used to stabilize the result.


Extensive tooth movement can also be carried out in adult patient. A multidisciplinary treatment requires a good cooperation of several departments.


  1. Drago CJ. Use of osseointegrated implants in adult orthodontic treatment: a clinical report. J Prosthet Dent. 1999 Nov;82(5):504-9.
  2. Fowler PV. Long-term treatment planning for single tooth implants: an orthodontic perspective. Ann R Australas Coll Dent Surg. 2000 Oct;15:120-1.
  3. Renouard F, Nguyen-Gauffre MA. Implants and orthodontics. Orthod Fr. 1997;68(1):161-70. French.
  4. Thilander B, Odman J, Lekholm U. Orthodontic aspects of the use of oral implants in adolescents: a 10-year follow-up study. Eur J Orthod. 2001 Dec;23(6):715-31.

This Poster was submitted by Dr. Karl-Ludwig Mischke.

Correspondence address:
Dr. Karl-Ludwig Mischke
Department of Orthodontics
Westfälische Wilhelms-Universität Münster
Waldeyerstr. 30
48149 Münster