Multidisciplinary Management of a Protrusive Malocclusion in an Adult Patient with Atrophic Ridges by Alveolar Ridge Split Technique - A Case Report
Authors:   Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India, Nanjannawar Lalita , Gofane Sanjivani , Keshaw Kunal , Pagar Sumit , Shetti Shraddha , Naik Nilima 
Published: August 2024

Objective: Closing old extraction spaces in adults can be an arduous task for the orthodontist. Loss of teeth results in alveolar ridge atrophy, reducing its height and labiolingual thickness which severely restricts orthodontic tooth movement. This case report highlights successful orthodontic treatment encompassing retraction of protruded teeth in an adult patient who presented with knife-edge shaped edentulous posterior ridges. Method: Esthetic and functional rehabilitation was achieved in this case with an interdisciplinary approach. The barrier of narrow atrophic posterior edentulous ridges which was inhibiting orthodontic tooth movement for retraction was overcome by bilateral alveolar ridge split followed by bone grafting. This procedure led to increased alveolar ridge height and width facilitating orthodontic space closure and retraction of forwardly placed anterior teeth. Simultaneously corticotomy cuts were placed in the mandibular anterior teeth region to accelerate the tooth movement as significant delay in treatment completion had occurred due to the pandemic situation. After achieving the required retraction of anterior teeth, the remaining edentulous spaces were managed with fixed prosthesis. Findings: A 22-year-old female patient was found to have protrusive and incompetent lips with acute nasolabial angle due to forwardly and irregularly placed front teeth with an overjet of 6mm. The patient had missing 35, 36, 45, 46, and 47 leading to bilateral posterior narrow edentulous ridges. The lateral cephalogram revealed skeletal class II jaw bases with vertical growth pattern and proclined upper and lower incisors. Clinical and radiographic evaluation post-treatment revealed significant improvements in smile aesthetics andperiodontal phenotype. Hence, augmented corticotomy assisted orthodontic treatment could be a promising treatment strategy in adult patients with posterior edentulous atrophic ridges. Novelty: This case report describes successful treatment of an adult patient with posterior edentulous ridges and forwardly placed anterior teeth which was a challenging situation in itself and got further complicated due to covid 19 pandemic situations wherein the patient had to discontinue her treatment for more than 2 years. After such a long break the chances of successful space closure were scarce and the patient demanded early completion of treatment as it was over delayed. Meticulous planning and execution of surgical interventions combined with accelerated orthodontic procedures helped to overcome all the hindrances, yielding a significant esthetic enhancement, improvement in functional occlusion and patient satisfaction within a short duration of time. Keywords: Ridge Split Technique; Atrophic Ridge; Bonegraft; Corticotomy; Accelerated orthodontics