INTRUSION VIA HYPEROCCLUSION. 3-month follow up. Andrews Intrusion Phenomenon.

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Posted on By Anton Andrews In Orthodontics

INTRUSION VIA HYPEROCCLUSION. 3-month follow up.
PDL widening is evident on the x-ray, as well as mobility of both upper right molars.
Patient reports neither pain nor discomfort around teeth, jaws,TMJ.

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14 Comments

A few questions as what you are reporting is considered one of the most difficult things to achieve in ortho movement, is often suggested as a cause of TMJ symptoms, and initates a "lesion of trauma" in the PDL which can exacerbate periodontal bone loss. How exactly do you explain this "intermitten" force application capable of intruding the opposing dentition when orthodontic literature describes more CONSTANT DIRECTED FORCE required for tooth movement?
Additionally, as our patients often complain of even the slightest high contact when we insert crowns, how do you manage their initial issues regarding contact ONLY in these areas and for how long? If patients do complain of TMJ related or CMDS how do you manage? Remarkable if possible as it changes the way we have all been taught in Ortho, Perio and Prosthetics...regards and thanks for sharing Maurice


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Interesting concept! But I agree with Maurice . How you stand from the legal point of view if anything happens to upper molars or TMJ? Gregory


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Gregory,
you can refer to this case , where I successfully intruded the second upper molar with the same concept for 0.5mm!
Patient has bruxism, nevertheless, she never had any complains you are concerned with.
http://forum.dentalxp.com/case/details/wide-diameter-immediate-molar-implants-/3481


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Maurice,
I will consider your comment as a "cautious compliment"
so thank you for that :)
As I had mentioned before, this is not my first case with INTRUSION VIA HYPEROCCLUSION.
But this case is on the extreme side for the following factors:
1. Pt is a bruxer
2. roots of upper molars 2/3 into the sinus
3. amount of planned intrusion is huge = 2mm
As an orthodontist you know how hard to move them through under these circumstances.
Nevertheless, At this 3-month follow-up I do observe what is expected with NOT EVEN SINGLE COMPLAINT from the patient.
Regarding TMJs, yes there is a transient cant of the mandible in the transversal dimension , since there is no occlusal stop on the left side present.
With # 2,3 had been loosen up and moving it will gradually diminish and then disappear.
I expect another 2-3 months will be needed to complete the intrusion.
BTW, you hadn't expressed any concern about the implants :)


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Anton

Nice video. Honestly, I don't know much about Intrusion Via Hyper-occlusion.
Was wondering about you thoughts on the bone density around the mesial implant/crown.
Love to see a image of the area 3 months prior...


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Anton. Very interesting thus far. How often do you see the patient and do you adjust the occlusion periodically to re-direct forces. I appreciate the update. Please continue to share. Best regards. Chuck.


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Thank you Charles,
I have seen the pt twice: in 1 month, then 3 months since loading. No occlusal adjustments yet.


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thank you Rocco,
please follow the link to see the whole treatment sequence
http://forum.dentalxp.com/case/details/intrusion-via-hyperocclusion-andrews-in/3999


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Anton,
it is very diffcult to value what you are clinically doing although you sent very nice film.
My perception is that occlusion has shifted on right side (premolars are not in occlusion) and lateral movement doesn't involve the cuspid, guidance made by lateral. You don't show protrusive and patient seems to have a very contract , uneasy and uncomplete movement.
Will be of interest to see how it'll evolve.
You may open new doors.
Armando


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Thank you Armando,
but I actually already had opened THE DOORS with Andrews Intrusion Phenomenon.
Besides I can explain it so it is not true phenomenon anymore!


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Anton. I'm still astonished. Please continue the follow up.
I'm worried about the implants. Have you noticed a little resorption or a bone condensation around them?
Any remarkable difference between bone at placement and now?
I can understand your "phenomen"on a growing patient...but on adults! This really changes my ideas!
Thanks for sharing!
Jorge.


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Jorge,
Bone reshaping is WNL around implants for this type of implant.
As for kids/teens vs adults, the same principles are applied with only difference in the host reaction/bone remodeling speed.


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The only thing the video shows is that 3 months is not long enough to witness the failure(s) which will include:
1. Fractures of the natural teeth
2. Pulpal deaths secondary to trauma
3. Muscle pain
4. Joint pain
5. Implant failure in one of its many possible areas ( screw loosening, screw breaking, bone loss etc.

I have no worries because you are ready and able to explain all of this away with all causes except the obvious one.


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Gerald,
It is well known that we humans are mortal.
Please refere to my other case 2-year follow up , where I successfully intruded the second upper molar with the same concept for 0.5mm!
Patient has bruxism, nevertheless, she never had any complains you are concerned with.
http://forum.dentalxp.com/case/details/wide-diameter-immediate-molar-implants-/3481


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