The lower front teeth often can be lost as a group even if just one is loose! This is because they are so close to one another. When bone loss effects one tooth it often affects your others as well.
In this case the lower right incisor (left on image) appears black at the gum line. It has a cantilever crown. It is loose and has bone loss. It had a root canal but did not help save the tooth. The gum has receded quite substantially. There are four incisors in total.
This is a person in their 60s who prefers to have the teeth look as natural and “age-appropriate” as possible…he wants them crooked and stained a bit!!
The plan is to correct the gum line, thicken the gum and make sure this patient is never without teeth.
5 Main Appointments:
1. Pre-surgical analysis and 3-D planning
2. IV sedation, extract four lower incisors #23 through 26, place only 2 implants in the lateral incisor position, take a piece of gum from the roof of the mouth and transplant the gum graft over the black root area, bone graft the voids, make an immediate fixed temporary so the patient never has to be without teeth
3. Follow-up 7-10 days later to check healing
4. Digital impression with trios and 3-D lab design for dental implant zirconia bridge
5. Place final custom abutments and zirconia bridge. X-ray confirmation that all parts are flush with one another
Total treatment time for the lower front was 3 months. This patient is currently undergoing additional implant treatment in other areas of the mouth. You can see on the final x-ray that the bone has filled in nicely around the area that use to be black on the x-ray.
These are challenging case is to do all in a single step and require substantial planning and expertise. The temporary bridge is not perfect but it is intended to give the patient a low-cost alternative for immediate placement and immediate teeth. The patient was on a soft diet restrictions in the area during the 3 month healing duration.
It is often a better result to replace all 4 lower incisors rather than trying to replace just one or 2. If you notice that 2 implants replaced four teeth. This will be stable for decades. I would encourage you to always make sure to consider the long-term prognosis. Everything looks good 1-2 years out but the test of time after 10 years is what ultimately counts!
He is thrilled to be complete.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry