Surgical treatment of unilateral severe overeruption and opposing alveolar atrophy

Overeruption with simultaneous alveolar deficiency is not uncommon but very difficult to treat. In mild cases of overeruption without opposing alveolar deficiency, selective removal of enamel from the overerupted teeth may be an option, yet not advocated. Extraction of the overerupted teeth should be avoided if the teeth are intact with sufficient bone support. The Schuchardt operation is a good option for cases limited to the overeruption. In cases of overeruption with simultaneous opposed alveolar deficiency, it is suggested to perform simultaneous maxillary and mandibular surgical procedures: alveolar segmental operation, followed by a sandwich osteotomy on the opposing arch. This article presents a posterior segmental osteotomy in the maxilla and a simultaneous sandwich procedure in the mandible utilizing the bone graft removed from the maxilla. The results showed good functional and esthetic outcomes. This method preserves the native teeth. It also utilizes an autogenous bone graft that is harvested regardless of the interpositional graft and spares a second surgical site. In addition, it allows for a one-stage procedure which enables for both treatment of the overeruption and augmentation of the opposing arch.