Posts Under Implants
This wondreful patient was tired of wearing a removable upper partial denture to replace a missing front tooth and decided a fixed option would be the right fit for her. She was also unhappy with the bonding and rotation of the adjacent front teeth.
A simple, single unit implant supported crown was placed to replace the missing fron tooth and the adjacent teeth were restored with the same ceramic as used for the implant restoration. A simple procedure with dramatic results!
Following a sports injury, this patient was left without a lower central incisor. Initially, the patient was using a removable prosthetic (partial denture) to replce this missing tooth. After wearing the appliance for a few years, the patient decided a fixed option was in order.
An implant fixture was placed with excellent inital stability. A temporary crown was fabricated so the patient no longer required the use of the denture. Once integration of the implant was complete, the patient was ready for the final prosthetic.
A scanpost was placed atop the implant fixture and a Cerec digital image was obtained. The Cerec software was used to create an Emax custom abutment as well as an Emax custom crown.
In the above images, the custom abutment has been delivered and torqued to 35Ncm. The access hole has been sealed with teflon.
The final crown was cemented and minor tissue recontouring completed with a Waterlase to sculpt the tissues into an esthetic emergence profile. With some additional restorative work (i.e. repair of the fractured canine and a full coverage crown for the adjacet central), the esthetics of this case would be complete.
What happens to a tooth once it has a cavity and subsequent restoration to repair this defect?
The life cycle of a tooth that has received a restoration is very predictable and has been well documented over the years.
The first area of decay for a tooth is usually the biting surface or proximal surface (i.e. between adjacent teeth). The initial restoration is small and usually free of sensitivity. As time goes by, the filling and surrounding tooth wear (from abrasion, acid erosion, thermal flexure, etc) and the filling fails. Moisture begins to penetrate the margins and recurrent decay develops. Most often, the restoration is not replaced in a timely manner because there are no symptoms with this process and the patient does not feel the treatment is necessary.
Once the patient decides they are ready for treatment, the old restoration is removed and a larger one placed to accomodate the damaged areas of the tooth. This means the width has increased, the depth has increased, the risk of sensitivity has increased (and the proximal surfaces are usually involved).
As the size of the resoration increases, so does the risk of fracture. Once recurrent decay develops around a filling of this stage, a fracture is inevitable. The fracture usually encompasses a large portion of the tooth and may encroach on the pulp tissue (nerve supply) of the tooth.
Further recurrent decay will develop with time and, when left untreated, will lead to even further fracture and risk for root canal therapy. As this point the only restorative option for the tooth will be a crown.
No restoration is permanent. Eventually the crown will require replacement. If the treatment has been delayed and even more tooth structure is lost, then the tooth may no longer be restorable and require extraction.
This doesn't sound very good, does it?! There are ways to prevent the progression from simple filling to extraction. The single most important thing is routine hygiene maintenance to keep restoration margins free of long-standing plaque and calculus debris. Routine radiographic and visual assessment of the restorations is necessary to detect failing restorations. Timely replacement of restorations can dramatically reduce the increase in size from one restoration to the next.
Choosing the right filling material can also improve the life-span of a restored tooth. Once the filling size has progressed to greater than 1/2 the intercuspal width or a cusp requires replacement, then a CEREC onlay, 3/4 crown or crown are the most durable and long-lasting options. They will reduce the risk of fracture dramatically!
If a tooth gets to the stage where root canal therapy, periodontal surgery and a new crown are required, one has to consider the long-term prognosis for the tooth. In some cases the prognosis will be good. In others, the prognosis may be guarded at best. At this point, replacement of the tooth with an implant-supported crown may be the best option. Implant treatment most closely resembles the original tooth and has an excellent pronosis - if cared for, they may last a lifetime.
In this case, the patient presented with a missing tooth in the 25 position (upper left second bicuspid) and a fractured tooth in the 24 position (upper left first bicuspid). Unfortunately, due to the extensive decay, the 24 was no longer restorable and required extraction. A variety of treatment options were reviewed with the patient including replacment of the missing teeth with implant-supported corwns, a long-span fixed bridge or a removable partial denture. The patient weighed the pros and cons of each type of treatment and chose to replace the teeth with implant-supported crowns.
At this point, diagnostic models were made and the patient scheduled with the oral surgeon to have the 24 extracted and two implant fixtures placed in the same appointment. The extraction and placement of two Nobel Active implant fixtures were carried out without complication. The patient was assessed a few days after placement of the implant fixtures and reported no discomfort.
The implant-supported crowns were fabricated following 3 months of integration time. Custom Zirconia abutments and crowns were fabricated and over-layed with porcelain. The crowns were seated using a screw-retained method and torqued to 35Ncm. These crowns will provide the patient with years of trouble-free service and if properly cared for, they can last a lifetime.
This is a question I am asked on a daily basis...
A dental implant is a titanium fixture (shaped a bit like a screw) that is placed into the jaw bone or alveolus for the purpose of replacing a missing tooth or teeth.
The procedure is quite simple, but requires careful planning and preparation to ensure the desired result. When a single tooth is to be replaced with an implant, the size of the space and quality of the bone are assessed and then an approriate implant fixture is chosen to be placed into the bone (there are hundreds of different types and sizes!). To place the fixture, the area is anesthetized with local anesthetic just as if a filling were to placed into a tooth. A small incision is made in the gum tissue to expose the bone and a hole is made using progressively larger drills to the desired size, depth and angulation. Then, the fixture is slowly turned into placed using a special torque driver. A cap is threaded onto the top of the fixture and the gum tissue is placed back to its original position.
After the fixture is placed, there is a waiting period of 3-6 months while osseointegration takes place - the surrounding bone will grow into the flutes of the fixture forming a bone/implant unit. Once osseointegration is complete, the implant is stable enough to recieve the final prosthesis. The cap is then removed from the top of the implant fixture and an impression is made of the area. The impression is used to form a dental model from which an abutment and crown are fabricated. The abutment is either made of titanium or zirconia and is attached directly to the implant fixtre in the bone. The crown is then placed over this implant abutment and either screwed or cemented into place. This completed dental unit if properly cared for will last a lifetime!
Implants are not just for replacing a single tooth. They can be used to fill larger spaces in the form of implant-supported bridges - not every tooth to be replaced needs to have a fixture. In this image, three teeth are replaced with two implants.
If the dental arch is edentulous (i.e. no teeth) a full fixed prosthetic can be made. Often 4-6 fixtures are placed and then the entire complement of teeth are attached to these fixtures. This is the ultimate replacement for dentures! This is a life altering treatment - patients will be able to eat things they haven't been able to eat since they lost heir teeth. Patients also experience a huge boost in self-confidence due the highly esthetic nature of the restoration.
Another option for the edentulous arch would be a denture (removable appliance) that snaps onto 2-4 implant fixtures. Anyone who has dentures would appreciate having something to attach their denture to; no more floppy dentures that move when you talk and eat!
If you are tired of your old dentures or embarassed by a missing tooth or teeth, please contact us and we would be happy to discuss your dental implant options.
Dr. Luke Haslam
Basinview Dental Centre