Restore a Dental Implant with Limited Space

Sometimes the interocclusal or the mesio-distal space adjacent to a dental implant may not be sufficient for the placement of a properly designed final restoration. In this post I will present you a technique that I co-developed to increase the mesio-distal space adjacent to unrestored dental implants. More information can be found in the article recently published in The Journal of Prosthetic Dentistry.

The simplified orthodontic technique presented in this post uses an osseointegrated dental implant as anchorage for an uncontrolled distalization movement. The materials used for this case include: a separator orthodontic elastic (Separators 640-0080; from Ormco Corporation), and auto polymerizing acrylic resin (Jet Set-4; Lang Dental Manufacturing Co).

Step-by-step instructions:

Sadly realize that the mesio-distal space available to restore the dental implant is not sufficient.
Restore the dental implant with a screw-retained temporary crown with a solid mesial and distal contact surfaces.
Insert a separator elastic in the distal contact point.
Assess and adjust the occlusion of the tooth distal to the implant.
Re-evaluate the patient after 7-10 days, remove the separator elastic.
Remove the temporary restoration, reline the contact point with auto polymerizing acrylic resin. It is important to get a solid contact surface.
Repeat steps 3-6 as needed.
Once the mesio-distal space is sufficient proceed to the final restoration as usual.

This is a simple technique that may come in handy for the management of minor mesial drift situation that occur around unrestored dental implants. In my experience the maximum distalization movement achievable is 1-2mm. Not much, but sometimes it is all you need. For more complex situation I will definitely consider a comprehensive orthodontic approach, and I would rely on the assistance of a board-certified orthodontist for those type of cases.