Pacific Coast Society of Orthodontists Bulletin Winter 2021 - 28

Clinical Practice

Pearls of the Pacific

Microimplants for Growing Patients
Dr. Andrew Levin
Huntington Beach, CA
PCSO Bulletin Contributor
Dr. Kevin Shimizu
Sunnyvale, CA
PCSO Bulletin Contributor

For patients missing their maxillary lateral incisors,
restoration with dental implants has become the
most common treatment option.1 The placement
and restoration of dental implants do not involve
damage to the adjacent teeth. When considering
maxillary lateral incisor implants for growing
patients, the skeletal development of the patient
must be heavily considered. If restorative implants are placed in growing patients, significant
periodontal, occlusal, and esthetic problems
can occur.2 A recently developed technique uses
microimplants to preserve the alveolar ridge in
growing patients.3 This technique involves the
perpendicular placement of a microimplant into
the palatal mucosa of the alveolar ridge in the area
of the missing lateral incisor. A stainless-steel wire
extending from the mini-implant serves as a retentive feature for a restorative composite pontic.
Two 6 × 1.5 mm microimplants were placed perpendicular to the alveolar process on the palatal side
of the missing maxillary lateral incisors, following
the technique of Ciarlantini and Melsen (Figure 1a).3
Next, an intraoral scan was taken, and a maxillary
3D cast was printed from the scan data. Using
the patient's maxillary cast, two 0.019 × 0.025-in
stainless steel wires were fabricated and shaped
appropriately to fit within the microimplants (using
a cross-type head) to offer retention for the pontics

(Figure 1a). Afterward, two pontics were fabricated
from composite resin with a hollowed-out region
on the palatal surface for retention to the stainless-steel wire (Figure 1b). Finally, the stainless-steel
archwires were secured intraorally to the microimplants with composite resin (Figure 1b), and the
pontics were bonded to the stainless-steel wire
with composite resin (Figure 1c).
Special thanks to Kevin Shimizu, DDS, MSD, for
his excellent treatment, lab work, documentation,
and restoration for this patient. Additional thanks
are given to Ivan Lo, DDS, MSD, and Laurie Chew,
DDS, for their help in documentation.
References
1. Romeo E, Chiapasco M, Ghisolfi M, Vogel G. Longterm clinical effectiveness of oral implants in the
treatment of partial edentulism: seven-year life table
analysis of a prospective study with ITI® Dental Implants System used for single-tooth restorations. Clin
Oral Implants Res 2002;13:33-143.
2. Thilander B, Ödman J, Lekholm U. Orthodontic
aspects of the use of oral implants in adolescents: a 10year follow-up study. Eur J Orthod 2001;23:715-731.
3. Ciarlantini R, Melsen B. Semipermanent replacement
of missing maxillary lateral incisors by mini-implant
retained pontics: a follow-up study. Am J Orthod Dentofacial Orthop 2017;151:989-994.

Figure 1. Overall fabrication of
lateral incisor implant-supported
pontics. (a) Insertion of implant
palatally with bicortical engagement. Three-dimensional print
model with 0.019 × 0.025-in
stainless steel wire fabricated to
fit implant placement. (b) Fabrication of lateral incisor pontics
and insertion of a 0.019 × 0.025-in
stainless steel holding wire into
implants. The 0.019 × 0.025-in
stainless steel wire was inserted
into the cross-type head of the implant and secured with composite
resin. (c) Intraoral center view of
insertion and final result.

PCSO Bulletin Winter 2021

Pacific Coast Society of Orthodontists Bulletin Winter 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2021