Case Study #2
Periodontics & Dental Implants Specialist, Dr. Veisman, serving the Greater Toronto Area
Extraction, Ridge Preservation, Dental implant and Final Crown
Patient Age: 39 year old Caucasian
Problem Presented: Pain/Abscess 21
Diagnosis: Fractured tooth 21
Treatment Recommendations: Extraction, ridge preservation, partial denture provisional restoration and eventual dental implant supported crown
Figure 1. Atraumatic extraction of tooth 21
Procedures Performed: Extraction, guided bone regeneration 21. An ovate flipper provisional was worn for 4 months of bone healing. Then, dental implant was placed followed by a crown three months later.
Figure 2. Clean Socket remaining
Specific Technology Used: Bone Regeneration; dental implants
Figure 3. Guided Bone Regeneration procedure completed with visible membrane in place
Outcome: Final crown in place for 10 years (since 2012)
Figure 4. Flipper provisional restoration 21 inserted and patient asked to wear it continuously for 1 week until the post-op appointment.
Conclusion: Bone can be regenerated predictably as long as there is very little VERTICAL (Apico-coronal) loss. Bone can be regenerated in a HORIZONTAL (bucco-lingual direction) with relative ease. There must be minimal pressure throughout the healing process of the bone graft by the provisional otherwise the bone healing will be unpredictable. As well, the oval pontic was designed to gently insert the denture tooth portion into the soft tissue so as to create an ovate soft tissue profile for superior esthetics later on.
Figure 5. After a week, the ovate tissue is taking shape and will be ready eventually for ideal implant crown emergence profile.
Patient comments before and after procedure: Patient was very nervous about what kind of results she would obtain from the procedures initially. She was amazed at how her final implant crown actually looked BETTER then her original tooth that she lost.
Figure 6. Final crown restoration on 21 is in place and consistently health for 10 years
What made our services stand out for the patient and the referring dentist is that we were able to accommodate the patient for treatment quickly and we were able to save as much of her own precious bone prior to building up on it. As well, a wax up was used to mock up the final crown prior to use of a surgical guide for ideal dental implant placement. The dental implant healed so well that within 3 months, she received her final crown.