Dental Implant: A case of an Implant at the lower front jaw

August 2, 2012 by Dr. Ng HW

A young lady had a lower  front tooth exacted a few months ago due to tooth decay and she came to us requesting for a permanent replacement of that missing tooth. She didn’t want a denture as it was a removeable appliance. She wanted something fixed in her mouth but wasn’t a bridge as she believe a bridge would damage her neighbour teeth.
Therefore, a dental implant was suggested to her.
After a few months a dental implant tooth was completed and she was quite happy about her implant now.
Below are the process of:

A simple case of Dental Implant Treatment

Patient was a24 years old girl, with no medical problem, non-smoker and practicing good oral hygiene.
According to SAC classification by the ITI (International Team of Implantology), the risk of placing implant in her mouth was: LOW

Assessment & Consultation

In October 2010, she came for assessment and consultation where the surgical date were fixed to the following week.

Front view
Top view

Surgery Stage/Day

On 9th October 2010 (surgical day), she came for implant placement. Local anaesthetic was given to numb the surrounding area which followed by raising the gum tissue (flap) to expose the jaw bone. The bone quality was assessed and preparation for implant placement began (lower left pic).
It started with a pilot drill to get the exact position right, then follow with the larger drill until the correct size to fill the fixture implant (lower right pic).

The flap was raised to expose the jawbone
The bone was prepared for implant placement
Implant fixture measuring 3.7mm diameter x 13mm length (lower left pic) was remove from its container. It was in a sterile condition and the surface is coated with titanium alloy to allowed osteo-integration  when in-contact with bone structure.
The implant was immediately place into the prepared site which was treaded before hand (lower right pic).

Zimmer Implant
The implant was screwed into the prepared bone
The implant fixture was hand-screwed into the bone at the final stage of the implant insertion. This was to allowed the surgeon to feel the resistance of the implant, and therefore the primary stability was achieved (lower left pic) .
The whole rough surface of the implant body was embedded into the bone until the furnish metal margine (lower right pic). Inspection was made on the front surface of the bone as to make sure there was no perforation!!

Hand-screw of the implant in final stage of insertion
The dept of the implant was checked
The implant holder (in green) was removed and the implant fixture was carefully check (Bottom).

Implant fixture placed in the jawbone
Another view of implant fixture
Before stitching back the gum, the top part of the implant fixture was covered with the sulcus former. This was to allow the gum to healed properly and to get a good emergence profile for the fabrication of the crown later (lower left pic).

Sulcus former was placed
The gum was reposition and secured with suture
The gum (or flap) was reposition so that it wrapped around the sulcus former nicely and was secured with the resorbable suture (upper right pic).
Finally,  a few stitch more to secured the vertical cut (lower pic)

The gum was suture properly

Prosthetic Stage (Two months later)

18th Dec 2010, patient came back and the gum was nicely healed. The sulcus former (green screw) was firm and intact. The recovery from the implant surgery was uneventful and patient was very keen for the final stage (Bottom pic).

2 month after implant surgery
The gum surround the screw healed nicely
The sulcus former screw was remove to expose the top part of the implant fixture and the surround gum tissue. There was no sign of redness showed that the wound healed very well (Lower left pic).
Impression coping was used to take the impression of the lower jaw as to make a duplication model of patient’s lower jaw (lower right pic).

Top part of the implant fixture and the surrounding healthy gum
Impression coping was used to take the impression of patient’s lower jaw
Then, the colour/shade of the crown was noted to match the neighbour teeth (bottom pic).
The impression record together with the crown colour selection were sent to the lab technician to have the abutment and crown fabricated.

Crown shade/colour selection
Two weeks later, the crown and abutment were ready for fitting (pic below).

Crown fabricated on the model

Fitting of the crown and abutment

18th Dec 2010 – the abutment (lower left pic) was fitted into the implant fixture in the mouth.
Then, using the torque wrench to tighten the inner screw to fix the abutment to the implant fixture (lower right picture).

Fitting of the abutment
Tightening of the abutment
The crown was cemented to the abutment with a strong cement and finally, the implant-crown was placed (Pic below).

Cementation of crown over the abutment
End Result!!

The implant in patient’s mouth

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