Multidisciplinary treatment in a case of loss of posterior vertical dimension

  • Teresa PinhoEmail author
  • Ana Norton
  • Manuel Neves
case study


Traumatic occlusion due to anterior crossbite malocclusion, missing posterior teeth and generalized moderate chronic periodontitis were some of the problems presented by this 58-year-old patient. The problems also included high mobility of the maxillary left central incisor, high gingival recession with attachment loss and periodontal deep pockets. The loss of supporting periodontal tissue was more evident on the maxillary left central incisor which was due to the traumatic position of the tooth aggravated by a forced anterior position of the mandible and a non-adjusted crown that promoted bacterial plaque accumulation. The absence of mandibular posterior teeth also worsened the clinical situation. Orthodontic treatment was performed only on the mandibular arch and implant anchorage devices were used to accomplish lingual inclination of the mandibular incisors. The definitive prosthetic treatment allowed reestablishment of appropriate esthetics on the maxillary anterior teeth with posterior stable occlusal contacts and eliminating the occlusal trauma. This condition promoted periodontal health of the left central incisor that remained stable over a 7-year follow-up. This clinical procedure with a long-term follow-up demonstrated that multidisciplinary management including orthodontics, implants and prosthetics can improve a debilitated traumatic occlusion and a severely periodontal compromised tooth.


Periodontics Orthodontics Implants Traumatic occlusion 


Conflict of interest

The authors declare that there are no actual or potential conflicts of interest in relation to this article.


  1. 1.
    Ong MA, Wang HL, Smith FN. Interrelationship between periodontics and adult orthodontics. J Clin Periodontol. 1998;25(4):271–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Shifman A, Laufer BZ, Chweidan H. Posterior bite collapse—revisited. J Oral Rehabil. 1998;25(5):376–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Pinho T, Silva JA, Alfaiate D. Orthodontic management of a case with missing upper posterior teeth, severe Spee curve and periodontal problems. Int J Stomatol Occl Med. 2012;5(4):188–97.CrossRefGoogle Scholar
  4. 4.
    Pinho T, Neves M, Alves C. Multidisciplinary management including periodontics, orthodontics, implants, and prosthetics for an adult. Am J Orthod Dentofacial Orthop. 2012;142(2):235–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Mihram W, Murphy N. The orthodontist’s role in 21st century periodontic-prosthodontic therapy. Semin Orthod. 2008;14:272–89.CrossRefGoogle Scholar
  6. 6.
    Thilander B. Infrabony pockets and reduced alveolar bone height in relation to orthodontic therapy. Semin Orthod. 1996;2(1):55–61.PubMedCrossRefGoogle Scholar
  7. 7.
    Miyamoto M, Yamashiro T, Takano-Yamamoto T. Surgical orthodontic treatment for severe maxillary protrusion with aggressive periodontitis. Orthodontic Waves. 2008;67:171–8.CrossRefGoogle Scholar
  8. 8.
    Drago CJ. Use of osseointegrated implants in adult orthodontic treatment: a clinical report. J Prosthet Dent. 1999;82(5):504–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Schneider G, Simmons K, Nason R, Felton D. Occlusal rehabilitation using implants for orthodontic anchorage. J Prosthodont. 1998;7(4):232–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Willems G, Carels CE, Naert IE, van Steenberghe D. Interdisciplinary treatment planning for orthodontic-prosthetic implant anchorage in a partially edentulous patient. Clin Oral Implants Res. 1999;10(4):331–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Kokich VG. Managing complex orthodontic problems: the use of implants for anchorage. Semin Orthod. 1996;2(2):153–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Ross IF, D’Onofrio ED, Roman JS. Occlusal contacts and tooth mobility. Females, aged 18–30. J Periodontol. 1972;43:760–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Ericsson I, Lindhe J. Lack of significance of increased tooth mobility in experimental periodontitis. J Periodontol. 1984;55(8):447–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Jin LJ, Cao CF. Clinical diagnosis of trauma from occlusion and its relation with severity of periodontitis. J Clin Periodontol. 1992;19(2):92–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Palomo L, Palomo J, Bissada N. Salient periodontal issues for the modern biologic orthodontist.. Semin Orthod. 2008;14:229–45.CrossRefGoogle Scholar
  16. 16.
    Johal A, Ide M. Orthodontics in the adult patient, with special reference to the periodontally compromised patient. Dent Update. 1999;26(3):101–4, 106–8.PubMedGoogle Scholar
  17. 17.
    Mathews DP, Kokich VG. Managing treatment for the orthodontic patient with periodontal problems. Semin Orthod. 1997;3(1):21–38.PubMedCrossRefGoogle Scholar
  18. 18.
    Wennstrom JL. Mucogingival considerations in orthodontic treatment. Semin Orthod. 1996;2(1):46–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Pinho T. Posterior scissor-bite and lateral open bite with missing lower first molar and second premolar. Int J Stomatol Occl Med. 2012;5(3):134–42.CrossRefGoogle Scholar
  20. 20.
    Ong MM, Wang HL. Periodontic and orthodontic treatment in adults. Am J Orthod Dentofacial Orthop. 2002;122(4):420–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Institute of Research and Advanced Training in Health Sciences and Tecnologies (IINFACTS)/CESPUSuperior Institute of Health Sciences-North, CESPUGandra, PRDPortugal
  2. 2.Faculty of Dental MedicineUniversity of OportoPortoPortugal
  3. 3.PortoPortugal

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