TAD Supported Space Closure in Agenesis Cases Bjorn Ludwig
Space open Vs space closure
Space opening
Space opening with implants – challenges
· Continued growth Zachrisson
o Relative infra-occlusion
o Solution – replace crown but pink aesthetics not addressed
· Vertical growth continues around adjacent teeth
o Age 30-40 upper dentition move backwards and downwards Bjork 1983
o Dental implants intra-occlude in adulthood until age of 60 Thilander 2001, Bernard 2004, Ghizlanzoni 2017 & Cocchetto 2019
· Orthodontic space opening = loss of bone, bony region has labio-lingual defect Uribe 2013
o Blue discolouring through for unilateral implants 57% Dueled 2009
o Root uprighiting is a biomechanical challenge
Space opening with bridges
· TAD bourne canteliver bridge
o Easy to change crown
Autotransplant teeth
· Rarely done in clinical practice
Patient centered approach to decision making
· Dental professionals shouldn’t not impose their view of aesthetics on the patient in agenesis cases Schneider 2019
· Phycology of spacing and bullying Iyad 2014
Space closure missing lateral incisors
· Implant site development
o Moving a tooth into the site of agenesis – develops bone
· Guided eruption
o Timing of extraction of peimary teeth
· TADs
o Push from labial side
o Pull from palatal side
§ To overcome friction / binding in system
o Iatrogenic risks 3rd palatal rugae
§ 0.18 risk of root damage if free-hand insertion
§ Non-parallel TAD placement
· Solution – TAD guide for insertion
o Slider TAD supported palatal mecahnics
§ Like final archwire – transverse and vertical effects
· Drawback round – no torque control
· Solution – fully customised appliances
o Aesthetics following space closure
§ Canine substitution = canine gingiva high Marco Rosa
· Extrude canines, intrude premolars
· Torque – using torquing auxillaries Warren or Goodman springs
· Aligners for finishing – best use of appliances
§ 4 in 3 position occlusal issues
· No TMD Rosa 2016
