Statement of the problem: Loss of teeth in either jaw will usually result in loss of function and aesthetics for the patient as well as loss of soft and hard supporting tissues. This bone loss is not limited to alveolar bone; portions of the basal bone may also atrophy and resorb. This continuing loss of bone is usually associated with treatment complications. In the case of the anterior maxilla, this can lead to aesthetic compromise if delayed implant placement is done following tooth loss, resulting in the need for multiple procedures to correct bone loss and aesthetic replacement. Endosteal implants are routinely used to stabilize and support a prosthesis for a missing tooth or teeth and are placed into the remaining native bone if adequate. The determination of what is adequate for implant support involves the need for pre-surgical PROSTHETIC EVALUATION and 3-D DIAGNOSIS.
This 3-D determination also includes bone location, volume, density, implant position, trajectory and the final screw retained prosthesis at the time of implant placement to allow the provisional crown to be screwed in place after grafting without need for a membrane and subsequent soft tissue changes.
It is essential to have 3-dimensional radiographic visualization of the implant site pre-operatively besides the traditional diagnostically mounted casts and radiographs to correctly place an implant with the needed trajectory for a screw retained provisional. At the time of surgery, a “Precision Surgical Guide” or surgical template is needed to initiate the correct implant trajectory, and osteotomes may be also be used to expand the site and allow high placement torque for implant stability. A single anterior tooth replacement with a one-stage replacement needs to have the implant lingual to the facial plate of bone to allow lingual screw access of the single crown. It also needs to have grafting of the facial space resulting from tooth extraction with a non-resorbable material such as HA to preserve the soft tissue contours and facial plate of bone with the screw retained provisional.
Therefore, using advanced dental imaging including cone beam computerized tomography, (CBCT) and a software program such as “Simplant,” an interactive software for implant planning and placement, can result in improved patient treatment with a one surgical stage approach when a “Precision Surgical Guide” is used along with a screw retained provisional.
We invite you to contact Reconstructive and Implant Dental Center at 913-492-2233 today for more information about teeth-in-a-day in Overland Park, Kansas, and to set up a visit with our prosthodontist, Dr. EDward M. Amet.