Dental Implant: A case of an implant placement over missing canine.

March 22, 2014 by Dr. Ng HW

A lady came to our clinic requested for dental implant to replace her missing upper left canine. Upon examination and radiography image taken, we found out that her missing canine is hidden way up in her upper jaw bone. (OPG below – white arrow)
The condition where the canine teeth develop displaced from their normal position is referred as etopic canine.

If we leave the etopic canine there and place an implant over the gap, there might be a chance that the implant will hit the etopic tooth. Therefore, after discussed with her, we decided to remove the tooth surgically and at the same time, we placed the implant into the gap. The extracted socket with be filled up with bone graft.

End result!!

How we do it?

1) On the surgical day

During surgery, an incision was made with scalpel blade to expose the canine area. The exploration was made way up to the alveolar bone to locate the etopic tooth. (Pic below: the ectopic canine lied high up in the upper jaw bone)

After the ectopic canine was remove, the implant site was prepare for implant placement. (Pic below: Note that there was a large empty space just above the alveolar bone)

Straumann implant fixture was place into the implant site. (Pic below: Note that the implant body can be seen expose in the cavity of the extracted ectopic canine)

The cavity of the extracted ectopic canine was filled up with xenograft — particulate bone graft origined from bovine (Bio-Oss). The purpose of this particulate bone graft was to cover the body of implant, attract and allow (osteo-conduction and osteo-induction) new bone cell to grow onto it and finally being replaced with the new bone matrix. (Pic below: Note that the implant (white arrow) was cap with cover screw and it’s body above was cover with particulate bone graft)

Then, a barrier or a membrane (Bio-Gide) was place over the surgical area especially on the the particulate bone graft. The purpose was to protect and prevent in-growth of gum tissue into the particulate bone graft. (Pic below: Black arrow — Bio-Gide membrane)

The flap (gum tissue) was approximated (left pic) before sutured with resorbable stiches (Right pic).

OPG radiograph taken immediately after the surgery.

2) Healing Phase

The would healing went uneventful

One week

3 months

3) Second stage surgery

3 months after implant placement, the implant was exposed surgically. The cover screw on the implant fixture was replaced with a healing screw (Left pic).
Excessive gum was remove using diode laser to allow a nice sitting of the crown on the gum later (Right pic).

4) Crown fabrication

After the surrounding gum healed one week after diode laser treatment, an impression and tooth colour was taken for crown fabrication (Left pic).

5) Issuing the crown-abutment

The one piece screwed-retained crown-abutment was fabricated from the dental lab technician. It was fitted into patient mouth and the biting was checked.
Finally, the crown-abutment was tighten with controlled torque force. The screw hole was cover with teflon tape (Right pic) before closing it up with resin composite.

One piece screwed-retained crown-abutment

Final Result