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Jul 2018

Dental implant to replace a missing premolar tooth- an article for dentists

Dental implants are the best way to replace a single missing tooth; at present there is no alternative that can offer the same benefits as dental implants. These include:

  1. A fixed tooth to replace the missing one
  2. The adjacent teeth do not need cutting down
  3. Preservation of the bone and gum tissue
  4. Restoring function to that of the natural tooth
  5. Excellent aesthetics as the new tooth emerges from the gum line
  6. Dental implants cannot decay
  7. Longer lasting than traditional alternatives such as dentures or bridges

In our presented case, the left first premolar tooth had been missing for about five years. During this time, the tissue resorbs (shrinks) which includes the bone and soft tissue. Therefore, in such a case, we have to plan initially and see what tissue is available for the dental implant. The only way to do this is by taking a 3-D CBCT scan. This gives us vital information in terms of width of bone, height available to the sinus floor, density of bone, angulation, the presence of any undercuts and all of the relevant adjacent teeth. The use of dedicated software such as Nobel Clinician, Blue Sky Bio, Implant Studio are very useful to determine the best position for the implant. A dedicated guide can be made to help the placement. Placement Once all of the planning has been completed, we can then place the dental implant. In most cases, the dental implant is placed under local anaesthetic for a single missing tooth. We have techniques which make the procedure as comfortable as possible using the use of laser. The Waterlase i Plus can raise a flap without the need for a scapel. It is also excellent at removing granulation tissue, excess tissue and making the initial osteotomy. We adopt a minimally invasive approach which involves using as much of the available bone as possible by expanding the sites rather than drilling away good healthy bone. We also harvest bone which can be used around the implant if any threads are exposed. This harvested bone can be mixed with artificial bone graft material if greater volume is required to cover exposed aspects of the implant or if we would like an improved profile of the soft tissue. Our preferred artificial bone graft is called Ethoss, which does not require a separate membrane and sets firm in situ. Healing The healing period is usually twelve weeks unless early or immediate loading is planned.

before dental implant for premolar tooth Healing abutment in place
Healed dental implant site- note the cuff of tissue surrounding the implant Healed dental implant site- note the cuff of tissue surrounding the implant

Restoration In most cases, we opt for screw retained restorations. This is because the crowns are easy to remove if required and there is an absence of cement which could extrude into the tissues and cause peri implantitis. The required torque is dependent on the system used, in the region of 25-35Ncm.

Dental implant crown- screw retained Dental implant crown- screw retained
Screw retained occlusal view. Access hole not visible. Screw retained occlusal view. Access hole not visible.

In the past, the screw access holes were visible and has a grey appearance due to the metal underneath. However, now with full contour zirconium, we can avoid that aesthetic issue and provide a restoration that looks just like a natural tooth. Maintenance Dental implants require greater levels of maintenance than natural teeth. Thorough interdental cleaning on a daily basis is required and regular hygiene visits are recommended. Failure to comply with oral hygiene regimes can lead to peri implantitis and loss of the implant in the long term. Article written by Dr Nissit Patel. All photographs are the property of Dr Nissit Patel.


Sep 2018

Case of the month September 2018

Our case of the month for September involves a dental implant to replace a missing molar tooth. Initially, the tooth was lost due to extensive tooth decay that was not treatable. This resulted in a space which affected eating. Although back teeth are not particularly visible, it is important to replace them for a number of reasons: Restore the bite Prevent movement of the adjacent teeth Prevent movement of the opposite teeth Preserve the jaw bone Aesthetics if visible on smiling In our case, the mi… READ MORE
Dec 2016

Case of the Month December 2016

Our case of the month for December involves the replacement of a missing lower front tooth using a dental implant. Dental implants are the best way to restore lost teeth; modern day techniques are minimally invasive, quick and virtually pain free. In our case, a lower front tooth was lost due to trauma. As you can see from the photographs, the tooth has been replaced with a virtually identical new dental implant crown. Before dental implant- missing lower front tooth After dental implant- life like and a… READ MORE
Nov 2016

Case of the Month November 2016

Our case of the month for November involves the replacement of a single missing tooth using a dental implant. There are many cases why teeth need to removed and in this case, the reason was due to a failing root canal treatment and infection. After the tooth was removed, healing is essential to allow the infection to resolve and the tissues to heal. The implant was placed with precision using a CBCT scan. Due to the advances in modern technology we can offer a wide range of solutions to restore teeth. Why… READ MORE
Sep 2016

Dental implants- what to expect

If you are missing teeth, then you have probably already done some research into dental implants. However, unless you have already undergone treatment you may be unaware of what the process involves. Well , we can simply it for you in 10 simple steps: Full diagnostic planning- a full clinical examination, x rays, photographs and study models CT scan of the area Digital planning on specialist software Fabrication of surgical stent if required Place dental implant(s) Allow healing of 12 weeks Ta… READ MORE


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