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FHDC’s Implant Dentist Robert Campbell, shares a recent case study…

A lady was referred to me March 2015 with a failing, broken down molar tooth on her lower left side. Assessment of the tooth showed that unfortunately it could not be saved (see photo below).

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We discussed all the possible options for replacing this tooth:

• Do nothing, i.e. accept the gap. This might seem the most straightforward option, but in more than 80% of cases, such gaps will allow uncontrolled movement of the nearby teeth. This may result in problems with the bite as well as food debris becoming trapped between the teeth.

A Bridge. This is a fixed replacement for a missing tooth, which is usually attached to the teeth at either side of the gap. Bridges can be very effective but permanently alter the teeth at the sides of the gap, and will need periodic replacement.

A Partial Denture (‘plate’). This is a simple, traditional way of replacing a missing tooth. The drawbacks are that they are not fixed in the mouth but removable, feel quite bulky and tend to affect the overall cleanliness of the mouth.

A Dental Implant, supporting a tooth-coloured crown

Our patient decided that she would like to be assessed for a dental implant.

CT scanning

The gold standard for assessment and planning of dental implants, is the CT (computed tomography) scan. In this situation, a small-area CT scan will provide very accurate 3D information about the size and shape of bone present in the area of the gap, as well as a detailed understanding of where important body tissues such as nerves and blood vessels are located. A decision was made to refer this patient to 360 Visualise, Ilkey, for a small-area CT scan, as well as removal of the failing tooth.

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The failing tooth was removed under local anaesthetic.

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Eight weeks later, a CT scan was created.

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Assessment and case planning using the CT scan data

Treatment Planning

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A meeting was arranged with our patient to discuss the CT scan findings. The area which was to receive an implant had a moderate amount of bone loss. A decision was made to place the implant in three months time to allow for further maturation of the tissues and a procedure called bone augmentation was planned. Bone augmentation encourages the formation of new bone around the implant. Bone augmentation is a safe, well-researched, effective technique which has been used globally for over twenty years to improve outcomes in dental implant treatments.

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A Straumann pure titanium implant was placed under local anaesthetic, together with bone augmentation. Pure titanium is very well-accepted by the body tissues, which allows an excellent connection to be made between the implant surface and the surrounding bone (Osseo-integration).
A follow-up phone call was made at the end of the day to check on patient comfort. Our patient was content and comfortable without having needed to take any painkillers.

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Short appointment to review healing.

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Review appointment. An x-ray of the implant showed an increase in the amount and density of the surrounding bone. Together with a careful check of the tissues inside the mouth, it was confirmed that excellent healing had taken place, and that the implant could now be restored. A healing cap was placed to begin to guide the gum around the implant into a useful shape to accept a dental crown.

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Impressions (moulds) were taken and a colour assessment made to ensure the final crown would blend in well with the patient’s overall tooth colour.

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Placement of the connector and final crown. Care advice was given and final photographs and an x-ray were taken. Arrangements were made to have a routine review of the area in twelve months’ time.

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Photograph of final result, implant-crown in centre position

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X-ray of final result, implant and crown in centre position

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A lovely testimonial letter was received from this patient, expressing great satisfaction with the outcome.

Conclusion

Although dental implant restorations usually need a longer overall treatment time compared with other options for replacing a tooth, there are often very significant benefits. In this present case, the outcome was:
• natural-looking
• strong and stable
• fixed in place
• as similar to the lost natural tooth as it is possible to get.

On a personal level I was very pleased with this case. Not only was the patient very satisfied, but I felt as though I had delivered some of my best implant dentistry to date. This is just part of the dental service that I provide at Far Headingley Dental Care and I find it very motivating to help our patients in this way.

Dr Robert Campbell BDS

If you have missing teeth or would like to replace a tooth with a dental implant, you can currently benefit from a free dental implant consultation with Mr Campbell. For more information please call the practice or follow this link.

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