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 dental implants 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
Thank you for your post on lower front tooth implants. It was very informative. I just learned from an endodontist that my lower front tooth #24 is necrotic with an acute apical abscess. Due to a calcified canal and the size of the radiolucency, I’m a questionable candidate for a RCT (50% or less chance of success). I’m told an apicoectomy doesn’t really offer a good long term solution because the untreated root canal almost always causes a re-infection, eventually. I’m in my late 50s with all lower front teeth cavity free and fairly straight due to adult orthodontics. I plan to consult an experienced periodontist in my area regarding implants and bridges. MY QUESTIONS: (1) Do you counsel your patients to try the RCT first (which I can afford) even when the outcome is questionable, i.e., do anything you can to try to save the natural tooth? (2) Would your answer be any different if a lower front tooth is involved? (3) Do you agree that apicoectomys are generally only good short term solutions, say 5-10 years? (4) Would the eventual failure of an apioectomy compromise the efficacy of a later implant on the tooth?
(1) Do you counsel your patients to try the RCT first (which I can afford) even when the outcome is questionable, i.e., do anything you can to try to save the natural tooth?
if there is an 80% chance that it will work then yes!
(2) Would your answer be any different if a lower front tooth is involved?
yes
(3) Do you agree that apicoectomys are generally only good short term solutions, say 5-10 years?
they are best for single rooted teeth like yours. Not molars.
(4) Would the eventual failure of an apioectomy compromise the efficacy of a later implant on the tooth?
sometimes but not usually
stay safe 😉
My lower teeth (front 4)are loosened and maybe beginning to start falling out and A shifted upper left tooth,bottom line..i have bad teeth”Lol”..My Smile has been my best feature and now i dont anymore 🙁 ..
Can my smile be Saved?
Ill take any suggestions! 🙁
Of course they can be fixed! You may be a candidate for exactly what you see here in this article. Keep in mind greater than 50% of the implants a place can be surgically inserted at the same time of extraction and many with same day temporaries!