This gentleman had a knock to the front of his mouth and fractured three upper front teeth. The left central incisor broke below the level of the gum and was replaced with a plastic temporary tooth done by the patient’s regular dentist, who then referred him to our clinic.
When we saw the patients 4 weeks after the trauma, the gums have settled, but he lost some bone along with the tooth that fractured below the gum line.
Because this patient had a large amount of gum display when smiling as seen in the before picture, it was critical to ensure that the surgery is meticulously planned and executed to avoid recession of the gums, which can cause asymmetry and aesthetic issues. At the same time, the treatment that we were about to embark upon would give us an opportunity to augment the gum line and change the amount of gum display to the patient’s liking.
In the first sequence picture, the fractured root remnants are visible still in the sockets. The teeth were very loosely attached to the roots.
After careful elevation of the fractured roots two dental implants were placed along with bone grafting and plastic soft tissue surgery in order to resurrect the bone that was lost in the trauma and reduce the risk of recession. The implants were fitted with healing abutments, visible as a blue and yellow disk in the gum in the second picture in the sequence.
During healing, this patient had to wear a denture, but it is more commonplace nowadays at our Melbourne clinic to connect a provisional bridge to the implants immediately after the surgery.
After 3 months of healing, the healing discs were replaced with Zirconia abutments, as seen in the 3rd sequence picture.
We also undertook a gum lift procedure on the lateral incisor tooth that was not damaged in order to reduce the amount of gum display and improve the choreography of the gum line.
A Zirconia Porcelain bridge was then permanently cemented to the dental implants, and a porcelain crown to the natural right lateral incisor, as seen in the last pictures in the sequence.
Fractured teeth are visible nestled within their sockets.
Following the removal of the fractured teeth, implants are placed on either end along with bone and gum grafting, then covered with healing abutments.
After 3 months of healing, zirconia abutments are fitted to the implants.
The Zirconia abutments are ready to support a, implant-bridge.
A 3-unit implant-supported bridge is permanently cemented to the abutments and a porcelain crown to the natural lateral incisor.
Less tooth display at rest than previously has been achieved for more balanced smile aesthetics.
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