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The Examiner

Online Edition
February, 2011
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Wade A. Diab, DDS, MS
3900 Frey Road, # 102
Kennesaw, GA 30144
770-426-1062

 

The Dilemma of The Failed Maxillary Anterior Bridge  

Trauma to the maxillary anterior teeth can cause significant dental and alveolar damage lasting a lifetime.  Many patients who were in their teens thirty years ago and sustained trauma to their anterior teeth had their damaged dentition replaced with fixed partial dentures.  Very often we see those patients in the dental office after going through two to three failed fixed partial dentures.  Throughout that progression, additional teeth are usually incorporated into the new fixed partial denture to provide extra support and compensate for weak abutments and lost teethNot surprisingly, a missing central tooth in youth can lead to the loss of more teeth thirty years later with devastating consequences.

 

The use of dental implants provides an escape from this cycle with excellent and permanent outcome. The biggest challenge in placing implants on patients who lost teeth due to trauma and failed endodontic treatment is the loss of bone and soft tissue volume.

 

In the following case presentation, I will demonstrate how the use of proper diagnostic tools and a surgical-restorative team approach to treatment planning will lead to very satisfactory results.

 

Wade A. Diab, DDS, MS

   

 Case Study  

A 39 year old male was referred to my office for the evaluation of a failed maxillary anterior bridge.  The patient sustained a trauma to his maxillary anterior teeth in his teens where he subsequently lost teeth # 6, 8 and 9 due to failed endodontic treatment and recurrent decay. His latest bridge is failing due to recurrent decay on # 5 and 11. Both teeth were deemed non-restorable. The remaining anterior teeth had previous endodontic treatment and are not good abutments for a future restoration. Significant gingival recession and loss of facial bone is noted on tooth # 7.

A CT scan of the area showed significant bone loss on the areas of # 8 and 9. Narrow alveolar ridge is present on the sites of # 6 and 7.

 

Pre-op
A smile picture at initial presentation
Pre-op retracted
Existing restoration at initial presentation














Pre-op x ray
x-ray of # 5 and 7
Pre-op x ray2
x-ray of 7
Pre-op x-ray3
x-ray of # 10 and 11
Scan 9
Cross section # 8
Scan 8
Cross section # 9


Treatment Plan:

The initial examination was completed and a CT scan of the affected area was acquired. The treatment plan includes the following:

1- Extraction of teeth # 5, 7, 10 and 11.
2- Insertion of implants in the sites of # 5, 6, 7, 10 and 11.
3- Simultaneous bone grafts on # 6 and 7.
4- Placement of temporary abutments on all implants.
5- Placement of a prefabricated cemented immediate provisional restoration.
6- Final restoration: 7 unit bridge from # 5-11 with pontics on # 8 and 9.

3d Model
3D volume with virtual implants 



Implants in
Extractions and implants placed on UR
Bone grafts placed on # 6 and 7
Abutments
Provisional abutments placed at time of surgery.
Gortex sutures used for superior healing


Post op x-ray
Post-operative x-ray
Narrow implant used on site # 7
Post-op x-ray 2
Post-operative x-ray
Narrow implant used on site # 10
Temporary smile
Immediate Provisional Restoration

 



Final Smile
Final Restoration
Final Retracted
Final Restoration
Moderate use of pink porcelain















The surgery was performed under IV sedation and the patient tolerated the procedure very well.  He was able to eat normally immediately after the surgery.  Three months of healing were allowed before the placement of the final restoration.  Limited use of "pink" porcelain was necessary especially on the site of # 7 where significant gingival recession was present at the time of initial presentation.




Restorative treatment performed by Dr. Tyler Baird at Baird Family Dentistry, Woodstock, Georgia.

All photographs are copyrighted and use without prior permission from Dr. Wade Diab is not permitted.

 2011. Wade A. Diab, DDS, MS 

Wade A. Diab, DDS, MS
Diplomate, The American Board of Periodontology 
Implants & Periodontal Artistry
3900 Frey Road, Suite 102
Kennesaw, GA 30144
P 770-426-1062
F 770-426-6789

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