J Oral Maxillofac Surg 67:82-88, 2009, Suppl 3 Prosthetic Considerations for Orthodontic Implant Site Development in the Adult Patient Alexandra I. Holst, DMD,* Emeka Nkenke, MD, DDS, PhD,† Markus B. Blatz, DMD, PhD,‡ Hans Geiselhöringer, CDT, MDT,§ and Stefan Holst, DMD, PhD Proper site development is a key factor for long-term clinical success of dental implants. Whereas surgical and restorative techniques have been refined to ensure predictable functional and esthetic outcome, individual clinical prerequisites do not always allow proper placement of implants when prosthetic and material properties are considered. Orthodontic tooth movement may be a viable and nonsurgical site development treatment option. With the introduction and advancements of minimal invasive and less visible orthodontic appliances, a growing number of adult patients are willing to obtain orthodontic treatment. The spectrum of modern appliances is broad and ranges from clear aligners to lingual brackets. Skeletal anchorage devices such as orthodontic mini-implants often eliminate unpopular external anchorage devices (ie, headgear) in adult patients, This article discusses the selection of an appropriate pretreatment approach by taking patient-specific criteria into account. © 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:82-88, 2009, Suppl 3 Although replacing missing single teeth with dental implants has become routine, in many cases the initial clinical situation does not provide for optimal implant positioning. Especially in adult patients with missing teeth, neighboring or opposing teeth may migrate, tilt, or extrude over years, making correct placement of implants impossible, or jeopardizing the long-term clinical success of a restoration. This is especially true if material properties are not considered and mini- mum dimensions are ignored. In addition, the practi- tioner is challenged with increasing demands for es- thetic outcomes, which require that multiple biological, functional, and biomechanical aspects be addressed and potential problems be identified preoperatively. The factors that have a direct influence on success or failure include the amount of available alveolar ridge, soft tissue type, correct positioning of the implant in all 3 dimensions, design and material of the selected restorative components, and adequate space for the definitive restoration. 1-3 Depending on the overall condition, an interdisciplinary team approach is indis- pensable for a predictable long-term success. Recent advancements in new materials and man- ufacturing techniques integrating computer-aided design/computer aided manufacturing (CAD/CAM) technology into everyday laboratory routine allow industrial fabrication of prosthetic components for almost any clinical situation. Despite their many ad- vantages such as biocompatibility, strength, and es- thetic properties, several requirements apply when materials such as oxide ceramics are used. In situa- tions where available space does not allow for mini- mum required thickness of components, material properties can result in catastrophic failure under clinical function. This is especially important when *Associate Professor, University Clinic Erlangen, Dental Clinic 3, Department of Prosthodontics, Erlangen, Germany. †Associate Professor, University Clinic Erlangen, Department of Oral and Maxillofacial Surgery, Erlangen, Germany. ‡Professor of Restorative Dentistry, Chairman, Department of Pre- ventive and Restorative Sciences, Robert Schattner Center, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA. §Dental X Hans Geiselhöringer GmbH & Co, Munich, Germany. Associate Professor, University Clinic Erlangen, Dental Clinic 2, Department of Prosthodontics, Erlangen, Germany. Drs Alexandra I. Holst and Emeka Nkenke state no financial ar- rangement or affiliation with a corporate organization or a manufac- turer of a product discussed in this article. Dr Stefan Holst has received honoraria from Nobel Biocare. Dr Markus B. Blatz has received re- search contracts and/or grants from Nobel Biocare, Ekton/Straumann, Heraeus Kulzer, 3M ESPE, Noritake, Kuraray, Coltene Whaledent, and Ivoclar Vivadent. Dr Hans Geiselhöringer has received governance and paid consultantship from Nobel Biocare. Address correspondence and reprint requests to Dr Holst: Glueckstrasse, 91054 Erlangen, Germany; e-mail: alexandra.holst@ uk-erlangen.de © 2009 American Association of Oral and Maxillofacial Surgeons 0278-2391/09/6711-0310$36.00/0 doi:10.1016/j.joms.2009.07.010 82