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Application of the 2-piece orthodontic C-implant for provisional restoration with laser welded customized coping: a case report
© Paek et al.; licensee BioMed Central. 2015
Received: 2 September 2014
Accepted: 2 March 2015
Published: 25 March 2015
This article presents the application of laser welding technique to fabricate an orthodontic mini-implant provisional restoration in missing area after limited orthodontic treatment. A 15-year-old boy case is presented. Two-piece orthodontic C-implant was placed after regaining space for missing right mandibular central incisor. Due to angular deviation of implant, customized abutment was required. Ready-made head part was milled and lingual part of customized abutment was made with non-precious metal. Two parts then were laser welded (Master 1000, Elettrolaser Italy, Verona, Italy) and indirect lab composite (3 M ESPE Sinfony, St. Paul, MN, USA) was built up. The patient had successful result, confirmed by clinical and radiographic examinations. Before the patient is ready to get a permanent restoration later on, this provisional restoration will be used. This case shows that a two-piece orthodontic C-implant system can be used to maintain small edentulous space after orthodontic treatment.
Space management is one of important issue during retention after orthodontic treatment. Although adequate space is prepared for definitive implants, some patients still want to postpone the installation of the dental implant due to several reasons such as high cost, difficulty in schedule adjustment, or residual alveolar growth in adolescent patients  and so on. In that situation, orthodontists usually deliver removable retainers incorporating the missing teeth. However full time wearing of the retainer requires remarkable compliance and if the patients’ cooperation is not satisfactory, the obtained space is easy to be lost.
A single-tooth mini-implant or small diameter dental implants have been reported to be a viable option as an abutment for a crown restoration with a satisfactory long-term period . The C-implant (Cimplant Co., Seoul, Korea) is a 2-piece orthodontic mini-implant system and its clinical application as a skeletal anchorage device has been reported [3-5]. The diameter of C-implant is 1.8 mm similar with other orthodontic mini-implants however, it has SLA surface and the threads with a smooth cutting edge which provide osseointegration like the conventional prosthetic implant. Therefore, the C-implant can be regarded as a miniature of dental implant which has good stability.
If the stability of provisional restoration using the 2-piece orthodontic C-implant is guaranteed, improved esthetics in coronal part is another important issue. The size of C-implant is ideally designed for any small edentulous area, thus facilitates esthetic fabrication of a provisional restoration by indirect build up method. C-implant should be placed following the angle of alveolar crest and buccal angulation of C-implant placement is inevitable in many cases. With buccally placed implant, angular correction should be carried out to fabricate esthetic implant restoration. Laser welding technique is introduced to correct the angle of implant abutment for esthetic restoration while maintaining the frictional fit.
In this report, provisional restoration using the 2-piece orthodontic C-implant as fixed retainer was described which meet both stability and esthetics.
Case presentation/technique description
Indirect lab composite (3M ESPE Sinfony, St. Paul, MN, USA) was then built up and customized staining was done to match the shade (Figure 6F). The final crown was slightly relieved from the occlusion to prevent overload of occlusal force since there is no long-term data reporting the strength of laser welding.
Considering the patient’s young age and anticipated growth potential, a definitive implant restoration for the missing tooth should be postponed until the general growth is complete. The residual alveolar bone, however, was expected to resorb if a conventional fixed or removable orthodontic retainer was used to maintain the space, since these appliances do not have bone-preserving properties. Therefore, an orthodontic mini-implant interim restoration is advantageous to prevent alveolar bone resorption and satisfy esthetic concerns and until general growth is completed in the next several years. The patient was informed about the need to have a final implant restoration upon completion of growth, since the gingival level of the alveolar crest of interim mini-implant restoration is expected to be more apical than adjacent teeth in several years . Another advantage of making interim restoration with orthodontic mini-implant is that the orthodontic mini-implant cast-crown restoration is significantly cheaper than the prosthesis on commercially available small diameter dental implants because the orthodontic mini-implant system does not require additional system-specific surgical kits, which increase the base fee of dental implant restoration. Not only surgical kit, but prosthetic components such as impression coping and implant analog are not required. Moreover, the C-implant system used in this report is two-piece system consisted of the body part and head part. As explained above, because the head part can be modified as abutment, there is no need to purchase another abutment. In this specific case, the size of head part provided maximum space for laser welding which enabled strong connection between head part and abutment. With previously mentioned advantages, the orthodontic mini-implant is gaining popularity as a viable option as provisional restoration in adolescent patients.
Laser technology is the most efficient method when applying thermal energy to small areas and it is one of the best fusion welding techniques for dissimilar metals. Therefore, laser welding under argon shielding is a useful method in joining titanium and its alloys, overcoming the high reactivity and strong affinity of titanium with gasses such as oxygen, hydrogen and nitrogen at high temperatures [7-10].
There are many other space maintaining options in partially edentulous adolescent patients. Non-invasive adhesion fixed partially denture and interim removable partial denture are widely used in many cases. However, the former cannot prevent alveolar bone resorption and it cannot be used when there is not enough space for the adhesion wing [11-13]. The latter has esthetic problem due to its clasp and compliance issues especially with adolescent patients. As described in this report, provisional restoration with C-implant is mainly for space maintaining, therefore, the focus is on esthetics instead of function. It will help maintain the bone level of the alveolar ridge and reduce the need for future bone graft. As the surface of C-implant is sandblasted and acid-etched, the long-term use of the C-implant for orthodontic anchorage has proven to be stable under multidirectional forces . However, there is no study reporting the long-term stability of the orthodontic mini-implant interim crown. Further investigation on the long-term stability will be needed. In this report, one-year follow up was performed and the result was satisfactory.
A 2-piece orthodontic C-implant system can serve as an excellent treatment option to retain edentulous space after orthodontic treatment until the future definitive restoration can be made.
Written informed consent was obtained from patient and parents for publication of this report and the accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
This study was supported by the National Research Foundation of Korea funded by the Korea government (MEST) (no. 2012R1A5A2051388).
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