This young man came to us complaining of his broken tooth (upper left central incisor). The tooth was root treated (RCT) many years ago and it fractured at the level below gum margin.

Before

The tooth was un-saveable  and extraction was the only choice.
Treatment option:

1. Immediate dental implant placement
2. Denture to replace missing front tooth
3. Full porcelain bridge

After discussed with him, he decided to have dental implant to replace that broken tooth and later crown for the right central incisor.

Final result

How do we do it?…

1) Surgical Planning

A few peri-apical radiographs, impression for study model as well as bone mapping were done for assessment prior to immediate placement of dental implant.
The surgical planning involved the location of implant placement, implant size and volume of missing bone needed to be replace with artificial bone graft.

2) Surgical Placement of Implant

A buccal gingiva flap was raised to have easy access to the  area.
The cracked tooth was removed as gentle as possible (atraumatic extraction) to preserve bone loss.
Then the tooth socket was clean and prepared for implant placement. Next, implant fixture was placed into the socket.

Placement of implant fixture

Facial bone resorption due to previous infection of the tooth, hence, the body of the implant fixture was exposed (picture below).

Loss of facial bone	The implant body was exposed

The bone defect was filled with artificial bone graft (picture below).

Bone defect was filled with bone graft	Bone graft can be from bovine or human

We overfilled the bone defect with bone graft as to prepare for resorption later.
The implant fixture was covered with gingival former and it was ready for closure.

Overfilled of bone graft	Gingiva former was use to cover the implant

The wound was sutured with resorbable suture (picture below).

 

3) Exposure of implant & impression taking for fabrication of crown

4 months later, sulcus former was removed to expose the top part of the implant fixture in the mouth (picture below).
Silicon impression was taken with analog screw to get a duplication on the implant and surrounding tissue for crown construction.

Top part of implant fixture was expose after 4 months	Gingiva healed nicely around the implant fixture

Shade/colour for the crown was taken (picture below)

 

4) Issuing abutment and crown

The crown on the model was fabricated from dental lab technician ready for patient.

Implant supported crown	Back view

Under the crown was the implant abutment which was the interface between the implant fixture and the crown (picture below).

Implant Abutment	Back view

The implant abutment was screwed onto the fixture (picture below). And the screw hole on the abutment had to be covered with cement

Abutment was screwed onto fixture	The screw hole was cover with cement

And finally, the crown was cemented onto the abutment

 

5) Crowning for right central incisor

A few months late, patient decided to have his right upper central incisor to be crowned.

Tooth preparation for crown	Crown on the model
Final result  !!	Back view

 

Conclusion

Before treatment
Implant on the left central incisor
Final result – crowning of the right cental incisor  !!

 

More Info

• Problems with missing teeth
• Dental Implant – Introduction
• Dental Implant – In-Depth
• Bone Graft
• Dental Implant: A case of  Implant placement at the lower front jaw
• Dental Implant: A case of an Implant at the upper front jaw – immediate placement
• Dental Implant: A case of an implant placement over missing canine
• Computer Guided dental Implant Surgery
• Fear of Dental Treatment? How to overcome it..?

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