The segmental osteotomy in the management of malposed implants: a case report and literature review

The segmental osteotomy provides an important treatment approach for the correction of skeletal-dental malocclusions that would otherwise be unmanageable with conventional orthodontic care. The combined use of orthodontics and orthognathic surgery also has been adapted for use in the correction of developmental and traumatic deformities. Severely malpositioned implant fixtures may not permit restorative correction even with custom prosthetic appliances. As an alternative to implant removal, which can be associated with significant alveolar destruction, orthognathic surgery may offer a treatment modality to improve fixture alignment, thereby enabling a more favorable esthetic and functional prosthesis. This paper presents a case report and review of the segmental osteotomy procedure.

A 32-year-old female with congenitally missing maxillary lateral incisors underwent implant surgery for prosthetic replacement of these teeth. Due to severe labial positioning of the implant fixtures, acceptable prosthetic treatment was not possible. A segmental osteotomy procedure was used to reposition the implants. The implants were splinted using a ridged interim suprastructure during the 4-month healing period. An occlusal appliance also was worn during the initial 8 weeks of this healing period.

The surgical procedure permitted intrusion and palatal repositioning of the implants. Healing proceeded with no untoward effects. Clinical findings at second-stage surgery were consistent with complete osseous repair and integration of the fixtures. Successful prosthetic treatment was subsequently completed for the patient.

The segmental osteotomy may provide an alternative treatment to the removal of severely malposed implants or their compromised prosthetic restoration.