I’ve been very fortunate to have tackled quite a few complex implant cases. Â For me, the hardest of these is the patient missing the lower anterior incisors. Â This situation presents some unique challenges.
- Combination Defect. Â Those who have lost their lower anterior teeth typically have periodontal disease. Â So they have both hard tissue (bone loss) and the accompanying tissue defect.
- Aesthetics. Â Anytime you have to replace pink the difficulty goes up. Â Where to put the papillae? Â How to match the pink? Â How not to make the teeth look too long?
- Implant Positioning. Â These areas have minimum bone width, limited prosethetic spacing, and often have divergent roots of the neighboring canines.
Here’s an example of a such a case and how we handled it. Â It’s not perfect, but overall I am pleased with the result.
Jerry has been a long time patient. Â He lost his lower front teeth due to perio disease.
Our first order of business was to do a ‘crown down’ prosthetic approach to implant planning. Â I did a virtual waxup using CEREC and merged it with his CBCT.
From this I was able to determine that placement in site #23 and #26 (my preferred sites) was not possible due to root divergence of the canines. Â Instead we needed to place implants in site #24 and #25.
Luckily, in this case there was enough bone width to avoid the need for lateral bone grafting. Â Even more important, we were able to plan the implants parallel.
This would give us the ability to produce a screw retained restoration with engaging abutments.
The final result is a screw retained bridge that replaces both the ‘pink’ and the ‘white’.
The final result is monolithic zirconia without any porcelain – just stain and glaze. Â Special thanks to Michael Keeter at Real Time Dental Lab for the lab work.
We make every effort to do nearly all our cases as screw retained restorations. Â Are you currenctly doing screw retained restorations? Why and why not? Â Please let us know in the comments section below.
Update 02/12/2016 – here is a picture of the provisional and the provisional in the mouth. Â As you can see i needed to adjust the provisionals in the mouth for working movements. Â This was then translated to the final restoration (above).