Case of a Patient With Failing Restorations
by Carlos Castro, DDS, FACP, Board Certified Prosthodontist | Georgia Prosthodontics
June 28, 2023
Case Summary
Patient “Mary” was referred to me by another dental professional in the area to improve the esthetics of an implant crown in the anterior segment. She was experiencing a recession of buccal tissue, which was leaving the implant body exposed.
An examination and a Cone Beam Computerized Tomographic (CBCT) scan revealed absence of buccal bone plate and implant angulation exceeding the limits of the occlusal area.
As a Prosthodontist, I have experience with complex cases and can plan multi-stage treatments that coordinate with a patient’s general dentist and other dental specialists. I am also comfortable treating patients with high esthetic demands. Mary felt comfortable knowing that I have experience with complicated dental issues, and have developed protocols to ensure the highest esthetic and functional outcome for the restorations.
Mary’s treatment included the following steps
Removed the implant and allowed the soft tissue to grow.
- Grafted the site and allowed for proper healing.
- A provisional was fabricated and retained from #8.
- A new implant was placed in a better orientation.
- Upon completion of healing time, a new provisional was used to contour the tissue, and a final impression analog was taken for screw-retained zirconia crown #9, and zirconia crown #8.
- Final crowns were inserted, and access holes closed.
This case was challenging because of these 5 items
- Mary had a high smile line.
- High esthetic expectations.
- Risk of bone loss from the surgery.
- Keeping the margins at equal height and symmetrical.
- Preventing future recurrence of tissue, so enough bone on buccal of implant had to be maintained.
For any implant case, especially one involving grafting, I advise allowing growth of soft tissue, letting one miracle happen at the time, and provisionalizing to envision the final outcome.