When both the tooth and root are damaged, the best permanent replacement is a dental implant in conjunction with a ceramic crown. This solution both looks and functions just like a natural tooth.

The most common method for replacing a single missing tooth is with a fixed bridge that is cemented to the teeth on either side of a missing tooth. With all fixed bridges the teeth adjacent to the space must be reduced to properly hold the bridge. The most conservative bridge is a Resin-Bonded Bridge (RBB), sometimes called a Maryland bridge. the resin-Bonded Bridge offers the advantage of minimal reduction of adjacent teeth to support the missing tooth. this type of bridge can only be used under certain circumstances.

A conventional bridge requires that the teeth on either side of the space be reduced in size to take room for crown which are then cemented onto the prepared teeth. The artificial replacement tooth is attached to these crowns prior to cementation. when properly maintained, the resin bonded bridge and the conventional bridge can last many years.

Implants can be considered to replace a single tooth. Often when the teeth on either side of the space are in good health, an implant may be the most conservative means of replacing the missing teeth because the adjacent teeth do not have to be reduced.

When two or three adjacent teeth are missing, a bridge may be the treatment of choice depending on the condition of the teeth next to the space and the bone supporting these teeth. The more missing teeth to be replaced, the greater the force that is placed on the remaining teeth which support the artificial teeth.

In some cases, when there are not enough teeth, a conventional bridge is not possible and a removable rartial denture will have to be considered to replace the missing teeth. A partial denture spreads the force to the adjacent teeth as well as to the underlying bone and gum tissue. A removable partial denture is less expensive than a conventional bridge. However, a partial denture is more bulky and less stable than a bridge and often times metal clasps will be seen when smiling. In some cases, the partial denture may cause deterioration of the natural teeth due to excessive forces.

When an implant is placed in the space where the teeth are missing, it can help by absorbing some of the load created by chewing forces and therefore make it eassier for the adjacent natural teeth to withstand the forces. When an implant is placed in the space where the teeth are missing, a bridge may be considered instead of a removable partial denture.

The conventional method of replacing all the teeth in a jaw is with a complete denture. If the jaw bone does not provide sufficient support, sometimes surgical procedures can be done to improve support and retention for the complete denture. These surgical procedures can include moving the position of muscle attachments or placing bone grafts.

A complete denture rests on the gums. In the upper jaw it also rests on the roof of the mouth. In addition to chewing forces being spread over a larger area, forces that might tend to dislodge the denture are offset by a suction which forms between it and the roof of the mouth. this suction helps to keep the denture in place. Most people are able to adapt reasonably well to an upper complete denture. However, a lower complete denture is considerably more difficult to wear. The forces are applied over a smaller area and due to the movements of the tongue a suction usually can not be developed.

The constant pressure on the gums under the dentures can cause slow changes in the underlying bone which result in the dentures losing their fit. For this reason complete dentures should be professionally examined at regular intervals, and when the tissues show sufficient change, the dentures should be relined, rebased, or remade, depending on the specific conditions. When improperly fitted dentures continue to be worn, the pressure may result in excessive bone loss. Eventually, so much bone loss can occur that a well fitting complete denture can not longer be made. Under these circumstances, implants may be the treatment of choice.

Implants May be placed at selected sites to help retain a denture. The implants can be connected by a bar or left standing slong to give the denture the added retention required. In selected cases it may also be possible to attach a permanent bridge to these implants.

As a leading provider of dental implants in San Diego, we provide this amazing service for our patients. If you have lost all your upper or lower teeth or even both, it is possible to effectively replace them with dental implants. Patients who have had this service, and did not have to use dentures any more, felt a sense of freedom, joy and improved self-esteem. They noted, eating, speaking and socializing was more enjoyable.

   

Healthy teeth make life more enjoyable, giving you a sense of well-being, and general comfort. A beautiful smile enhances your appearance and can provide added confidence and presence.

Cracked Bicuspid
This 48 year old female presented with a chief complaint of a cracked tooth. Upon examination it was found that she had fractured the lingual (inside) cusp of her left upper first bicuspid.

It was fractured below the gum line to the crest of the bone. The main reason it fractured was the existence of a large amalgam filling which weakened the tooth.

The patient had two treatment choices. We could perform root canal therapy, place a post and core, and then do a crown lengthening procedure to expose more tooth structure. Doing so would have required removing some gum tissue and bone. Then place a crown on the tooth.

The other option would be to remove the tooth, place an implant and immediately place a temporary crown.

The patient opted for an implant and crown.

To do an immediate load implant, certain criteria have to be met. There has to be adequate bone, a large enough implant needs to be placed, and the implant once placed has to be able to resist at least 40 ncm of force.

The temporary crown has to be adjusted so that no forces are placed on it during function. Meeting these criteria allows the bone to grow around the implant (osseointegration). After a period of nine weeks a permanent crown can placed.

The following picture sequence demonstrates an ideal situation for an immediate load implant or what I call a Vanity Crown because the patient refused to go out in public with a missing tooth.

A template was made of the tooth prior to removing the fractured cusp so as to facilitate fabrication of a temporary crown.

An important factor in this procedure is to carefully remove the tooth without removing any bone in the process.

In this photo, we are using a periotome, a thin instrument, to separate the root from the bone.

The photo here shows successful removal of the broken bicuspid and all root material.

The remaining boney socket (darker eliptical area) can be seen after the tooth was removed.

The socket was prepared with sequentially sized bone drills to accept a Nobel Biocare Select 5.0mm x 13mm implant.

In this photo the final sized drill bit is being used.

The implant is placed and tested with a torque wrench to see if it can be displaced with a force of 40 ncm.

This implant was proven to be extremely stable.

Next we customized a zirconium abutment and attached it to the implant with a torque of 35 ncm.

One of the advantages of using a white zirconium abutment as opposed to the silver colored titanium is that there is no graying of the overlying gum tissue.

This is an immediate post operative x-ray taken showing the implant, zirconium abutment and temporary crown. Note how well centered the implant is between the canine and 2nd bicuspid.

The size of the implant and surrounding bone give more than adequate anchorage to place an immediate abutment and temporary crown.

The last photo shows the fitting of the temporary crown (Vanity Crown) that enables the patient to avoid the "toothless look" she was fearful of.

After 9 weeks, osseointegration has been achieved (bone material has completely integrated the implant substance), the permanent porcelain crown will be placed.

The porcelain material will be matched precisely with the patient's existing teeth. Future cosmetic considerations for the patient include replacement of old amalgam fillings, all ceramic crowns, porcelain veneers and Zoom teeth whitening.

The new concept

The new concept represents a giant step forward in the development of implant treatment protocols that are easier and more patient friendly. By combining a unique planning program, a surgical template and the immediate loading concept , it is possible to surgically place implants in bone using a flapless approach and to insert a fixed bridge during a single appointment.

Treatment solution

At the present time, this treatment solution is only intended for edentulous jaws where:

• sufficient amount of jaw bone exists
• the quality of the jaw bone is adequate for immediate loading
• opening the mouth at least 50 mm is possible (important especially for lower jaws while teeth are present in the opposite jaw)
• the health of the patient is not compromised

A unique planning and treatment solution

The Teeth-in-an-Hour protocol is a unique solution made possible by the Procera ® System. A custom fabricated precision drill guide and a pre-manufactured prosthesis, based on CT images and virtual planning, can be made before surgery. The major decisions of the treatment are made during the planning. The execution of the implant placement that follows is performed with minimal surgical intervention.

Computerised technology

The rapid development of computerised tomography (CT) scan techniques with decreased radiation and 3D computerised imaging technology has made it possible to fully visualise the placement of implants in a real 3D environment.

High precision

The use of surgical templates to place implants has been shown to provide added value and surgical templates with high precision sleeves have optimised prosthetic rehabilitation since planning is both anatomically and prosthetically driven.

The result

Teeth-in-an-Hour allows the possibility to provide patients fiexd, well-functioning, and esthetic prostheses on implants in less than an hour. Thanks to the flapless technique, this treatment will be a totally fantastic experience for your patients with

• greatly reduced healing time
• no temporaries
• no significant pain nor swelling

1. Patient's first visit to the clinic

• Impression making
• Occlusal index

2. CT scan

3. Dentist/surgeon planning on the computer

4. Dental laboratory

• Surgical template
• Index
• Fixed bridge

5. Second visit to clinic

• Implant placement
• Delivery of fixed bridge