THE SINGLE DENTAL IMPLANT WITH CUSTOM ABUTMENT AND CROWN 

The treatment for replacement of a missing tooth in the dental arch allows for several restorative options. Conventional techniques include a removable partial denture, a cemented fixed bridge and a resin-bonded fixed bridge. Each of these options can be successfully used. However none of these alternatives can actually replace the original tooth and the way it emerges from the gingival tissue and it's ability to maintain the bone height. A prosthetic tooth, supported by an endosteal implant, may be the closest match to the natural tooth.

For a single missing tooth, the conventional removable partial denture would be an option of last resort. It is bulky, unesthetic, and can be difficult to wear. The three-unit fixed cemented bridge is certainly a time-tested prosthetic treatment option. However, it requires that adjacent teeth, often intact, be prepared as terminal abutments. The acid-etched resin bonded bridge was first introduced as a conservative approach to tooth replacement. Most resin-bonded bridges involve nonrestored teeth, with minimal tooth preparations, to serve as retention. This bridge often results in overcontoured attachments on the lingual resulting in plaque traps. In a 10 year retrospective study, an overall debonding rate of 31% occurred.

The implant-supported fixed prosthesis is an excellent alternative to replace a missing tooth if there is adequate width and height of remaining alveolar bone. Therefore, treatment planning for an endosteal root form implant requires accurate planning, but can result in a very realistic natural appearance that aides in maintaining bone height. The ability to restore the fully edentulous mandible and maxilla through the use of endosteal implants has expanded to include the partially edentate population. Conventional dental treatment options such as the removable partial denture, the three-unit fixed bridge and the resin-bonded retainer may need to be reconsidered now that endosteal root form implants have been proven effective. The prosthetic tooth, supported by an endosteal implant emerges from the tissue attached to a "root" (the implant), in a manner which more closely resembles the natural tooth it replaces than any other treatment option available. In a clinical situation where there is adequate bone and adjacent virgin teeth, the single tooth implant restoration can certainly be considered as the primary treatment alternative.

Fig. 1: An example of a treatment Needed for a single implant to replace a missing lateral incisor

Fig 2: Pre-Operative Radiograph 

Figure 3                                                  Figure 4

Fig. 3:  Naturally Occurring Concave Appearance is Result of missing tooth

Fig. 4:  Temporary Replacement of Missing Tooth During Patients Active Orthodontic Treatment. 

The restored tissue contours are the result of bone expansion with implant placement.

Fig. 5: Post-Operative Implant Placement Radiograph

Figure 6                                                      Figure 7

Fig. 6:  Normal healing process with rebuilt ridge and implant ready to be restored

Figure 7:  Custom fabricated abutment with provisional restoration gives patient full function and

time to evaluate the appearance before the final crown is constructed.

Changes in appearance and function can easily be made at this time and evaluated before the final restoration is made.

Fig. 8: Radiograph Showing Abutment and Crown 

       Fig. 9: The final restoration appears to "grow" out of the supporting tissues with natural appearance

        Fig. 10: Seven Year Follow-Up

Fig. 11: 15 Year Follow-Up

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