Classical approach on posterior vertical space Treatment

51 Rating(s).


Posted on By Jorge Campos In Occlusion

This is a classical approach to a very and almost daily office situation. Patient wants lower mollars back. We implant but...upper mollar is extruded.
What do I do? Same as allways.
Recently we saw a different approach introduced by Anton Andrews. We are following up his case in which he intrudes by supraoclussion the upper mollars.
Comments?
Jorge


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9 Comments

Excellent and Classic approach to this dilemma. The only issue would be the long term stability of the buccal furcation that is now Class II? Otherwise, just great and an approach I use the same way. Thanks for sharing Mo


Reply

Jorge. Given the circumstances this is an excellent approach. Other options would include extensive Orthodontics or extraction / implant. I believe Anton's intrusion technique would be ineffective given the amount of extrusion combined with the palatal inclination. Nice result. Thank you for sharing. Best regards. Chuck.


Reply

Maurice and Chuck.
Thanks for your comments.
If Anton Andrews tech works I would stop doing this, because it is easier and benefitial for patient.
But I still would like to understand how predictable it is.
If the furcation zone is flat, furcation is not an issue on my expirience.
Thanks for comment.
Jorge


Reply

Andrews intrusion phenomenon works!
Currently I have two cases in progress.
The one presented on dental xp is very tough because of pneumatised sinus so it will take longer.
Another one is intruding the lower first molar against 9x9 mm upper implant after sinus lift!
I'll keep you updated!


Reply

Anton. How would you manage a case such as this one? Are there limits to your approach? Do you feel you could design a crown to intrude a molar with poor axial inclination such as this case? Maybe use a crown designed for intrusion then replace with another? Best regards. Chuck


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For this case I would use a palatal wire with activated omega loop for the transversal correction and hyperocclusion on implant crowns.
I would start with palatal wire first, followed by intrusion in 6-8 weeks.
I have done it only with 7+mm diameter. I wouldn't risk it with even two small ones (regular) . Also crowns in my case were FCZ, no porcelain


Reply

Im not that familiar about the fine points of this approach.
Seems to me that it will take some doing to intrude this upper molar with the lower molar. Even though you are dealing with a implant/crown not a tooth/root. I can't imagine not having some damage to the mandibular molar bone and soft tissue. Not to overlook discomfort.

I had a max bi cuspid crown that was high ( out of occlusion )
for a long time. It was a pain in the ... And inevitably had to be extracted. What a relief

I cannot believe that this intrusion is comfortable. Just some of my thoughts

Rocco


Reply

Rocco, all that is true when there are teeth against teeth.
For some reason my patients report no discomfort with hyperocclusion against implants.
That is ,partially, why I call it phenomenon.


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Thanks Anton to show up here!
This case I present here is what I´ve been doing for so long that I was impressed about what you do with the "intruding phenomen".
I did, intrusion on mollars but in growing children and with bilateral crowns, can´t imagine as Rocco said that this is painless and discomfortless when it is unilateral. Also for the TMJ balance.
Thanks for answering and I´m waiting to see your results ...just to copy! Ha, ha.
Thanks, Jorge.


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Hu-Friedy
Salvin