More often than not and especially in emergency cases, patients are undecided about the method of tooth replacement they desire a the time of tooth removal. As a result extractions are done in a conventional manner and even with the utmost care bone defects can be  created during the process of extraction. The natural process of bone resorption during healing after extraction can also make things even more complicated.

The case presented in the slideshow below is one where after the emergency extraction, the patient was given a removable partial denture also commonly called “flipper”. After a few weeks of wearing the flipper, the patient could no longer bear with discomfort of the flipper. After review of available options, the patient opted for a conservative, natural , metal free and non-removable method of tooth replacement. A  zirconia crown supported by a ceramic dental implant which is  also made of zirconia was selected to be the method of tooth replacement.

As part of our diagnosis and treatment planning protocol, a low radiation dental CT (CBCT) scan study of the area with the missing tooth  was completed and it was discovered that as a result of the extraction and the loss of bone volume the site of implant placement was compromised. We were also able to determine the remaining bone density/quality, predetermine the exact volume of bone to reconstruct, select the accurate implant size and predetermine the crown shape. The exact location of the maxillary sinus floor was identified and assessed because maxillary sinus perforation can some times occur when implants are placed in the posterior upper jaw. With so much information gleaned from the dental CT scan we were able to safely and predictably place a zirconia dental implant and immediately seat a fixed temporary crown on the implant the same day it was inserted in the jaw.

After a bone integration period and soft tissue maturation of four months, the temporary acrylic crown was removed, impressions were taken and a permanent zirconia crown was fabricated and cemented to the implant.

Today there is an increasing amount of people who choose to have their teeth replaced with dental implants. In some cases the replacement is immediate meaning that once teeth are removed, during the same surgery implants are placed to replace those previous teeth. The advantage of replacing a tooth with an implant at the time of extraction is that the amount of bone loss at the site of extraction is greatly minimized.  However for most people the decision or option to have their teeth replaced comes long after their teeth were lost, and after years of wearing removable partials, dentures or having fixed bridges anchored to adjacent teeth. The problem often encountered in  such cases is that the bone in the area where the teeth have been missing shrinks and there is significant loss of volume and height making it challenging to place implants . A bone augmentation or reconstruction procedure is then necessary and occasionally must be done prior to and in preparation for implant placement, this is what is commonly called a bone graft.

When situations of bone loss or long term absence of teeth present themselves the first step is to obtain the proper information for accurate diagnosis. A clinical and ultra low radiation 3D X-ray is taken of the jaw to be treated, the x-ray unit we use in our practice is called a Cone Beam CT Scan (CBCT) and it provides an accurate view and analysis of the problem. The slide show below shows how by means of clinical pictures and  dental CT scan we are able not only to plan the volume of bone that needs to be augmented but also with a second scan assess the success of the bone graft.

This is a case where the patient lost a front tooth a few years before. As time went by the patient realized that wearing a removable partial denture also called “flipper” was very uncomfortable and affected the ability to socialize with confidence. Dental implants had been contemplated for a long time but there was an objection to titanium dental implants which are metal. Also a history of allergy to various metals was of concern. As a result the only option for non-removable metal free tooth replacement was a zirconia dental implant. The implant was placed and immediately oufitted with a temporary crown and within an hour the patient left the office with a fixed metal free tooth.