This businesswoman had 2 missing teeth, the upper right central and lateral incisors. The dentist replaced these two missing teeth with a fixed bridge supported by the patient's natural teeth on either side of the gap. But over time the bone in the section the teeth were lost had resorbed, a process that naturally occurs following a tooth extraction, and the gum has lost volume. This resulted in poor gum aesthetics.
This lady’s dentist referred her to our clinic for dental implants.
However, implants alone would not have solved the aesthetic issues caused by a lost gum volume. Also, we had to consider whether to place one or two implants to support the two lost teeth.
When titanium fixtures are placed in close vicinity to each other there is a known phenomenon of collective bone loss that may occur, which causes further recession and would have been counter-productive to what we were trying to achieve. We decided to place only the single implant and have it support a 2-unit bridge. The question often arises as to whether a single fixture can support two teeth. The answer is different from patient to patient, but generally, in the front of the mouth the biting pressures are not as high as in the back of the mouth and it is not only possible but in fact preferable to replace two feet with a single implant.
In order to resurrect the lost gum volume, we also performed connective tissue and gum grafting, along with bone grafting, – all down at the same time as the implant surgery.
We made the patient a temporary bridge, which we fitted over the same adjacent teeth that supported the original bridge.
After 3 months of healing, we connected a titanium abutment to the implant and fitted a 2-unit bridge, with the lateral incisor cantilevered and supported by the central incisor. The adjacent teeth that in the past supported a bridge both received porcelain crowns to match.
The caving in of the gum is visible under the right central and lateral incisors (left of centre in the picture).
The dental implant is visible in the left central incisor area covered with a healing cap. The adjacent teeth that used to support a bridge will be fitted with individual porcelain crowns.
A titanium abutment is fitted to the implant to support a 2-unit cantilever bridge replacing the two missing teeth.
The implant bridge is in place showing the improved gum volume from the augmentation procedures that took place at the initial surgery.
This x-ray shows the implant supporting a cantilever bridge. The thin white lines in the roots of the adjacent teeth are prior to the root canal treatments that had been done.
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