A Case of Simultaneous Treatment for Protrusive Mouth, Root Canal Treatment, and Implant Placement

A Case of Simultaneous Treatment for Protrusive Mouth, Root Canal Treatment, and Implant Placement

Just as various diseases can be treated together,

teeth can also be treated consistently

when they are facing different problems.

So this time,

while improving a protrusive mouth through orthodontic treatment,

we also performed root canal treatment on areas with cavities,

and implant placement in areas with missing teeth,

in order to create an overall proper oral environment.

Because this was a combined treatment,

it may be especially helpful for people who need multiple treatments,

like the patient in this case.

The patient’s initial reason for visiting

① Improving a protrusive mouth

② Implant placement

So first, we examined the overall oral environment

with a panoramic X-ray.

The anterior teeth were crowded due to excessive overlap,

and the upper jaw had even erupted wisdom teeth,

resulting in a very tight dental arch.

The lower jaw had missing molars in several places,

so it was expected that eating had been uncomfortable.

Molars are very important for chewing,

so when those areas are lost,

it becomes difficult to chew hard foods,

and force is concentrated on the front teeth,

which can cause fracture and wear of the incisors.

Over a long period of time,

the opposing molars may also over-erupt,

so it is better to treat them so they can function as much as possible.

The cephalometric image showed

gingival and dental protrusion,

and that the teeth had moved excessively beyond the esthetic line.

After analyzing the measurement points,

it was clear that substantial posterior tooth movement was needed

to bring things into the normal range.

You can see the protruded front teeth shape,

and in this condition,

front-tooth use is not good,

making eating uncomfortable.

The lower teeth may irritate the gums,

which can even lead to periodontal disease,

so caution is needed.

A skeletal asymmetry pattern was also visible from the front,

so we decided to proceed with customized treatment

taking multiple factors into consideration.

1. Bracket attachment → molar treatment

A protrusive mouth should be treated over at least

1 year and 7 months to 2 years or more,

and if the protrusion is severe,

it may take even longer.

So if treatment other than orthodontics is also needed,

it is better to receive the additional procedures

after the braces have been attached.

Therefore, for this patient,

the orthodontic appliances were first attached overall,

and then root canal treatment for the molars was performed.

Molars usually have 3 to 4 roots,

so root canal treatment takes a bit longer,

and because many root shapes are curved,

it is a more difficult procedure than treatment for front teeth.

*The long stick was an instrument used to measure the root length.

After removing the occlusal caries and accessing the canal openings,

we measured the canal length, removed the source of contamination,

and used disinfecting materials

to sterilize the canals.

After that, we carefully filled them all the way to the root tips

with a stable material.

As a result, you can see that the three roots

were neatly completed in white.

They appear white because they were filled well

with restorative material

and sealed with resin.

Fortunately, the roots were not blocked

and were straight,

so the procedure could be completed easily.

2. Using mini screws for effective improvement of a protrusive mouth

One of the very effective materials in dentistry

is the mini screw.

This material, also called a mini screw or mini implant,

is essential in orthodontic treatment

because it effectively helps with tooth angulation, rotation,

protrusion, and movement.

As a source of anchorage

that helps apply force properly,

it can shorten the overall orthodontic treatment period,

which is also an advantage for the patient.

These mini screws were placed

in the areas where teeth were missing.

When a power chain is connected to the wire and pulled,

it receives force well and can move more easily

after being guided in the desired direction,

which can create better results.

Sometimes people worry about the small gum hole,

but it closes in about a day or two after removal,

so there is nothing to worry about.

Also, because there is almost no pain during placement,

it should be less uncomfortable.^^

Because the patient had severe dental and gingival protrusion,

mini screws were placed on both sides,

and more force was applied with power chains.

You can see that the anchorage was placed well in the empty spaces, right?

It was not yet a result beyond expectations,

but since the brackets were also being maintained well without falling off,

we decided to keep observing.

3. Implant placement after resolving protrusion

After reducing the protrusive appearance to some extent,

it is better to begin the implant process

before adjusting the bite.

That way, better results can be achieved

in terms of both time and occlusion.

Therefore, at the appropriate time,

we took a CT scan to thoroughly analyze the alveolar bone width and density,

selected the exact location,

and proceeded with implant placement.

After extracting the lower left wisdom tooth,

we firmly placed fixtures in the areas that needed implants.

After a certain period of time,

we checked the stability and then beautifully restored the area

with a crown after the abutment.

This is the periapical view after being covered with a crown.

It was placed firmly at the correct intervals,

and there is abundant surrounding alveolar bone.

This is the arch image after the retainer was attached.

Since the horizontal overlap was resolved,

the midline is correct even when viewed from the side.

As the shape became more rounded,

the occlusion is showing an ideal condition.

Looking at the cephalometric image,

you can see that the protrusion has been resolved more clearly.

The esthetic line has also improved,

and the overall proportions have become smoother.

The lips also became slimmer than before.

This time, we introduced a case of combined treatment,

after performing protrusive mouth correction,

root canal treatment, and implant placement simultaneously.

During the orthodontic treatment period,

we were able to save time by carrying out

not only orthodontic treatment but also root canal treatment and implants.

If you need multiple types of treatment like this,

it may be possible depending on your oral condition,

so if you have questions about orthodontic treatment or other procedures,

or if you need treatment,

please leave a phone call or a comment.