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Replacing a long lost tooth with a dental implant

02/03/2017

Replacing a long-lost tooth with a more permanent solution is not always an easy task. Teeth like the upper or lower first molar or an upper central or lateral incisor are often missing from a young age. These cases normally arise due to failed root canal treatments, fractures or even trauma caused by a road traffic accident.

The status of the tooth site may vary considerably with the time lapsed to the type of incident causing tooth loss. Other factors such a tooth position as well as dental and oral health, also play an important part. Taking, for example, the loss of an upper central incisor, this tooth is often lost at a young age; typically between the ages of seven and 12.

Dental implant

The trauma would, more often than not, necessitate a root canal treatment. At the younger end of the spectrum, the root development is often incomplete, jeopardizing the long-term prognosis of the tooth. When more mature with its root end closed, the prognosis is better. This tooth, however, may still not offer a good prognosis. At times, the trauma is so extensive that the tooth either falls out of its socket and is lost, or fractures at the mid or apical third of the root and must be removed at once. Soft tissue, as well as bone, is often lost. Once the tooth is out the ageing process starts taking place. The bone surrounding the area does not receive any biting stimulus and so starts resorbing. The gum also recedes and reduces in size.

Over the years the area suffers considerable tissue loss resulting in difficulty for the implant surgeon to restore the area to the functional and aesthetic norm. The best way to replace a tooth with the above history is with a dental implant. However, not until long ago, the typical replacement was with a bridge or a denture. Today we know better and try not to involve adjacent teeth like when using a bridge. A denture, too, remains an undesirable removable prosthesis and where possible, should be eliminated. The implant carries many advantages. Besides being an independent structure it also reduces the bone/gingival tissue loss and when done properly facilitates hygiene maintenance.

CASE STUDY

A young woman in her late thirties has a history of losing her upper central incisor in her teenage years. She has worn a fixed bridge attached to the one tooth on either side of the missing incisor. Over the years the gum and bone have receded leaving a large space and unaesthetic noticeable defect. She also has a high smile line exposing all the defects in the gum. Although she knew that a newer bridge would have already improved her smile, she opted for an implant, regaining three individual teeth instead of a three-tooth fixed bridge. Bone was harvested from the lower wisdom tooth area and grafted in the area of the long-lost tooth. Four months after the grafting, an implant was placed with some minor additional bone grafting. Once healed, she had three new, all-ceramic single crowns fit into place.



 

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