There are case reports of placing implant trough Impacted teeth but the success rate is still questionable
- ABSTRACTSReport on 3 patients who received unconventional implant treatment because of the presence of impacted teeth.
- Case presentation and evaluationImpacted teeth, 3 patients
- DiscussionTreatment planning of these 3 cases with impacted teeth evolved over time ...
- Materials and methodsInclusion criteria and general requirements
- ResultsClinical and radiographic evaluation of the implants
- Key words:
- impacted canine, impacted teeth, implant integration, implant placement
- Placement of Implants Through Impacted Teeth. Three Case Reports
- Unconventional Implant Placement.
These cases, although limited in number, suggest that implant placement through an impacted tooth might not interfere with implant integration or harm occlusal function, at least in the short term.
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The aim of this paper is to report on 3 patients who received unconventional implant treatment because of the presence of impacted teeth. To avoid invasive surgical removal of the impacted teeth and delayed implant treatment, implants were placed through the impacted teeth. Of the 7 implants placed into 4 impacted teeth, all healed uneventfully except a short (8.5-mm) implant that became mobile after 4 months. One and 3 implants have been now loaded for 3.5 and 2 years, respectively. These cases, although limited in number, suggest that implant placement through an impacted tooth might not interfere with implant integration or harm occlusal function, at least in the short term. More study is warranted before this unconventional procedure might be considered as a possible clinical option when, at an impacted tooth site, clinicians seek to avoid invasive surgery. (Int J Periodontics Restorative Dent 2009;29:405-413 .)
Epidemiologic data show that, after the third molars, the canines, followed by the premolars, are the most frequently impacted teeth.1–3 Impacted canines are rarer in the mandible than in the maxilla,2,3 but their respective frequencies vary widely from country to country and from center to center.4,5 The impaction rate ranges from 0.07% to 1.3% for the mandibular canine2,5,6 and 1% to 3% for the maxillary canines. 3,7 The location of the impacted canine is typically palatal in the maxilla and labial in the mandible. Overall, up to 3.6% of the population is affected by impacted canines4; this occurrence might be as high as 9.3% in patients with malocclusion.8 Therefore, canine impaction cannot be considered an uncommon finding.2 When impacted teeth are asymptomatic, surgical removal might not be necessary.9 Sometimes, however, patients seek rehabilitation of the site, eg, when the primary canine is lost, and the presence of the impacted tooth must be dealt with. Treatment usually requires that either the canine be moved orthodontically to the ridge, when feasible,1,3,10 or the impacted tooth be surgically removed before an implant is placed.1,11,12 In both cases, the treatment is usually lengthy13 and associated with higher treatment costs. When surgical removal is contemplated, implant placement is performed after completion of bone healing. Sometimes, however, removal of the impacted tooth is so invasive that the bony site must be reconstructed prior to implant placement; this is particularly common when the canine is labially impacted
In a previous paper,14 5 patients were treated with the following unconventional implant placement scheme: in the anterior maxilla, implants were inserted transradicularly through the root canal of nonvital ankylosed teeth and were left in contact with root fragments. The aim was to avoid an invasive surgical extraction leading to gross bone damage. 14 In the same way, the present authors sought to avoid removing vital impacted canines through invasive surgery. The aim of the present paper was therefore to report on 3 patients with implants placed through impacted teeth. The patients and their treatments are described and the results are discussed
Method and materials
Inclusion criteria and general requirements
To undergo this unconventional treatment, the following conditions had to be met
1. Patients had to be healthy and able to maintain good hygiene.
2. Implant therapy was indicated.
3. The impacted teeth had to be asymptomatic and free of surrounding pathology.
4. When treatment planning was discussed with the patient, it was explained that extraction might be complex and invasive and would necessitate additional augmentation procedures before implant placement.
5. The patient had to request an alternative that was less invasive and promoted earlier delivery of the implant-supported prosthesis.
6. After of the protocol and its deviation from standard care were explained, the patient had to accept the risk of implant failure. In case of implant failure, traditional treatment with an augmentation procedure was warranted at no additional cost.
7. An informed consent document had to be signed.
Patient 1 The first patient (Fig 1) was a 62-yearold woman who sought rehabilitation of the maxilla. Bilaterally, horizontally impacted canines were present in sites intended to host implants (Figs 1a and 1b). Seven Osseotite implants (Biomet/ 3i) were placed. Three osteotomies among them were drilled into the impacted canines (Figs 1c and 1d), and implants were placed as follows: 3.75 311.5 mm at the right canine, 3.75 3 8.5 mm at the left canine, and XP 4/5 3 15 mm at the left first premolar.
Figs 1a to 1c : Patient 1. Pretreatment periapical radiographs. (left) Right side with impacted canine; (center) mesial migration of both impacted teeth; (right) left side and impacted canine. Note the failing premolar, which had provided retention for a removable posterior prosthesis
Fig 1d (left) Postplacement periapical radiograph of the right side. The mesial implant has been placed through the impacted canine.
Fig 1e (right) Periapical radiograph of the left side after implant placement. The 2 mesial implants have been placed through the impacted canine. The mesial implant is short (8.5 mm long); it failed after 4 months of healing.
Figs 1f and 1g Periapical radiographs following removal of the impacted canine. (left) Right side; (right) left side.