Hi it's Dr Adrian Kat from Advanced Dental Artistry here in West Perth
Immediate front tooth replacement with the dental implant.
Well, six months ago, I did Part One of this video
and that was really the surgical procedure of how we actually did this treatment.
How did we remove the tooth and actually immediately replace it with a dental implant
that also have a temporary tooth on the top?
There was a lot of views of that video
and the main reason is, it's a very common problem when we look at dental trauma
50% of the population will get some sort of dental trauma
all the way from a little chipped tooth,
all the way through to knocking a tooth out or several teeth out actually.
So having trauma in the front tooth is actually very common.
Let's give a quick summary of how this treatment came about
and I will just summarize it very very quickly.
When we look at the tooth, you can see if the tooth is dark,
it's dead, there's cracks all over the front of the tooth
and the patient had a root canal but that root canal have failed.
There was a root fracture and there was some root resorption.
So these tooth can't be saved.
So when we're looking at a young patient that needs their front tooth tooth replaced,
the best option of course is a fixed option
where we're actually replacing the tooth with a dental implant.
So you can see here what we've done is you remove the tooth atraumatically.
It means we're removing the tooth without any damage
we then remove the tooth - as you can see there's no tooth here
we then have used a Nobel Parallel implant here.
It's a narrow implant (NP3.75) and we're using a narrow implant
because we know that if a wide implant is placed,
there's a large possibility that the bone on the front of the tooth
will actually dissolve once the implants place it's about three mm under the CEJ of the adjacent tooth
and slightly palatal so we can use a screw retaining crown.
We then, of course, have a gap between the bone on the front of the tooth and also the implant
So this is when we place our artificial bone in this area
In this photo here, we've also put a scan body, 3D scan body.
So we're able to actually scan the case so we can altually get a porcelain crown made.
The other problem we have, of course, is that the gum on the front can actually dissolve (resorb).
So what we've done is we've taken a soft tissue
from the palate and we've actually placed it on the front,
the buccal part of the front area and this is to thicken this area up.
What we're doing is we're really ensuring that if there is any shrinkage down the track,
that we've actually got more gum than is actually needed.
From here we've got some options when it comes to the temporary tooth
We can either use an immediate zirconia which we can actually get made if you have an on-site lab
or in this case, we've used a temporary cylinder
and the most important thing is thing is this profile
How do we actually get this beautiful emergence profile
that not only makes the tooth look real but and also supports the soft tissues
and this is actually placed. The only time that we can actually do this is if the implant goes through
to a high-torque and we're really talking above 45 Newton centimeters
and then we can screw this directly in. You can see the results here.
So here you can see the stitch. We've got a stitch actually holding the connective tissue graft in place
and you can see the immediate results here.
That is a resorbable suture and that suture will dissolve.
It's a Vicryl Rapide™ probably dissolve after about 7 to 10 days
and that will allow the patient's gum to actually heal nicely.
So when you see some of these photos, let's all get some immediate photos here
and you can see that the temporary looks really good. You can see it slightly shorter.
We've taken out of bite, so there's no pressure of course in the tooth
and you can see that it is slightly shorter a bit out of bite
but one of the things that we saw immediately was that the gums was a lower
and this is important. It's lower than the adjacent tooth.
So we've got excess gum early on.
Ok, we are going to see some complications with this case,
that's actually really good because then we can actually talk about how we can actually do with those complications.
So this case is going to be left for six months. In certain cases, when it comes to dental implants,
we only have to wait for 3 months for the bone to go into the implant
but because we did a bone graft with this case,
we actually left it for a period of 6 months
and she was very happy we left it for six months.
She had a beautiful looking temporary tooth
it didn't really change her appearance.
So the temporary tooth was good to actually last six months.
So let's see what happened after six months period.
During this healing phase, this is around about four to six weeks after we did the implant in
you can actually see that the healing is actually excellent the temporary tooth looks really good.
We then forward six months.
So let's look at what happened over the six-month period.
Well, now, you can see that we have a defect,
We got a defect on the distal aspect, the back implant of the tooth.
You can actually see that this distal aspect, we've lost the gum.
There's a defect in this area and we're going to have to correct this.
As I said to you before, one of the most important thing is when we're dealing with the front teeth
is not just about making sure that we put a tooth in there
but it's also to make sure that it looks as natural as possible and that is the gum and the supporting structure
so this is gum and bone.
So what we're going to do here as you can see at this stage,
we're going to start to make a permanent porcelain crown for the patient.
This is a screw retained in the crown and you can see that we made it in two parts.
So the main reason for that is we have a lot of problems actually with these cases
because of shade. When you're trying to shade match a front tooth to another front tooth
especially the central incisor,
it's a very challenging case and the technicians have to be real artists when it comes to these cases
to ensure that this is actually correct.
So the temporary crown comes off and you can see how beautiful the soft tissues are.
We then placed the new or the the implant crown,
the new implant crown directly into this area and already we can see some problems,
So let's go through some of these problems.
the first of cause is the gum.
So when we look at the area, we really talked about how the gum actually is lower.
There's a defect actually in that area and that defect shows that darkening.
You can see that darkening right on the distal aspect of that area
and that's going to be a problem for us that saying that we're gonna have to address
before the final crown goes in.
When we actually also look at the next problem,
we can see, is we can see that on the natural tooth is these little white flecks
and these little white flecks helps him make the teeth will be natural
on the new crown, you can see that there's no white flecks.
So of course that means that for a patient and for us when we're dealing with it,
we really want this result to be beautiful.
So that's something that we have to change.
The other issue with the length.
The length of tooth is slightly shorter than the tooth on the left-hand side.
The patient's left-hand side.
What we're going to do is we're going to have two lengths in their area
and the last thing we can see is there are going to be some challenging situations
because the lateral teeth are different.
If the lateral teeth are different it will actually make the central tenth of a slightly different
and this is something that we're also going to have to deal with.
So what happens is we took that out, we rescan the area,
we took more photos, we put the temporal tooth back in.
The patient waited for another week while the ceramist spent even more time
making sure that this front tooth was actually perfect.
So all of those minor changes were actually done.
So in these front teeth, they are complex not because they're in the front of the mouth
that does make it quite challenging
but because not only do we have to make sure that the implant is in the right position,
we have to make sure that the soft tissues are great
which means that we had to do a second gum graft on that distal area to build it up
and we have to make sure the cosmetics are absolutely perfect
which is all those very very minor details in order to actually get the cosmetics as beautiful as possible.
If you have any questions, please give us a ring at the practice.
You can leave comments below if you do want our opinion when it comes to cases,
please drop us an email or leave your comments below.
I look forward to one day seeing you in the practice