A restorative solution for a missing incisor

Thomas Sealey presents an aesthetically challenging case to restore a missing upper left central tooth.

This case presentation demonstrates a unique approach to an aesthetically challenging restorative solution for a missing UL1 due to a less-than-ideal placement angulation of an implant by another dentist. This case was complicated by the patient being incredibly nervous and exemplifies what can be achieved with careful prosthetic planning and a good understanding of the available dental materials and technologies.

Presenting complaint

This 44-year-old male patient presented with a loose temporary bridge replacing his UL1. He had received placement of an immediate post-extraction implant only four days earlier after falling and hitting his mouth on a taxi door. He had received the implant from another dentist. This author re-made his temporary bridge for him using fibres to add additional support and bonded this to his adjacent teeth. The author did not anticipate seeing the patient again, as this was an emergency appointment before the weekend.

Three months later, the patient contacted the author requesting implant restoration, explaining that the dentist who had placed the implant had left the country (Figures 1-3). After some communication with the implant clinic where the patient had received the treatment, it transpired that he had an Astratech Osseospeed EV implant placed. This was good news, as it is the system this author uses for implant restorations, and was therefore familiar.

After an initial consultation, the patient consented for this author to continue the restorative treatment on his UL1.

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Diagnosis

This gentleman was not a particularly regular attender and was almost dental phobic – he was shaking in the chair during early visits. He had a high-power job and exhibited hallmarks of stress-related parafunction. His anterior teeth had severe tooth wear and loss of canine guidance.

His oral hygiene…