I would like to present another case of a single implant for upper front teeth that I did recently. The patient was suffering from advanced gum disease with generalized excessive bone loss. His teeth were generally mobile and sensitive to cold. He was unhappy with the status quo of his oral health and wanted to improve his oral wellness.
Upon examination, I noticed a few cavities. The upper left incisor was hopelessly loose and decayed. The patient was missing his molars on his upper right side, and two of his lower molars had post-treatment endodontic disease. The two endodontically treated molars were hopeless in their prognoses. After a couple of excellent and thorough cleaning by my hygienist, his gum disease has improved tremendously. He was also educated on the causes of gum disease, ways to combat the illness, and preventions.
A comprehensive treatment plan was drafted, presented, and discussed with the patient. I like to treat patients holistically, so I modified the plan after considering his inputs like wants, priorities, fears, and finance. With this holistic approach, he accepted the final treatment plan involving fillings, extractions, and implant-supported crowns.
Fortunately, the patient was motivated to keep his mouth healthy, so his periodontal health improved significantly. The cavities were first treated with white composite resin fillings that contained no bisphenol A (BPA). Before I added an implant for upper front teeth, the original upper front tooth had to be extracted. A Straumann implant was then inserted surgically in the same appointment. Bone graft and guided tissue regeneration techniques were also employed to generate more bone around the implant as it was healing, similar to the previous case I presented in my other blogs.
Fig 1 – X-ray, front, and occlusal view of the tooth.
The missing front tooth was temporarily replaced with a bonded resin tooth for the first four months. A new temporary tooth was made chairside using the machined titanium base covered by composite resin by me at four months to replace the bonded tooth. To improve the visual harmony of the front teeth, I filled the chip of the central front incisor beside it and modified the shape to reduce the diastema.
Fig 2 – X-ray of the BLX Straumann implant in place.
Fig 3 – A bonded temporary tooth to replace the missing.
Fig 4 – A temporary tooth attached to the implant.
The gums were allowed to reform and model around the temporary resin crown for about two months before a “permanent” crown was made to replace the resin crown. The permanent crown was made with esthetic lithium disilicate that is strong and life-like.
Fig 5 – A permanent crown supported by an implant integrated into the bone.
The patient was happy with the esthetic result and functionality of the implant-supported front tooth. Since then, I have placed two more implants in his upper right side where he has missing molars, and I will share the progress with you in my future blog.
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