Immediate Dental Implant Placement in the Anterior Aesthetic Zone

Immediate Dental Implant Placement in the Anterior Aesthetic Zone

Severe bone loss on lower anterior four teeth (23, 24, 25 and 26)

Today we are going to inspect how to place dental implants if you need to remove several of your front teeth. Losing your front teeth can be more difficult than losing back teeth since they are more visible. As a result, most patients desire to have their treatment completed in as little time as possible.

Immediate Dental Implant Placement

Immediate implant placement means placing the implants at the same time as removing the bad teeth. When planned accordingly, immediate dental implant placement provides the opportunity to cut treatment times in half. Plus, it spares the patient an additional surgery, since everything is done in one visit.

Case Analysis

60-some year old white male patient with a healthy medical history.

Problem

Severe bone loss affecting the lower front four teeth (teeth #23, 24, 25 and 26). There is significant mobility and substantial bone loss affecting all the four teeth. Teeth show between 70 to 85% bone loss. Additionally, teeth 24 and 25 have decay which makes them likely to break at any time.

Four teeth remove and two implants placed (the two healing caps are visible)

Treatment Plan

Removal of lower four teeth and immediate placement of two dental implants. The lower anterior region has excellent bone which makes it a great candidate for immediate dental implant placement. However, it is important to keep in mind that the lower front four teeth have very small roots. Whenever a patient is going to lose their lower front four teeth on the bottom region, the treatment plan almost always involves placing two dental implants (not four) and connecting these two implants via a four unit bridge. The middle two teeth receive a bone graft instead of dental implants.Why 2 instead of 4 implants? Because there is not enough room in this region to place four individual dental implants. In contrast, the same treatment involving the upper four teeth would typically include four individual placed dental implants.

Treatment Time

Immediate dental implant placement allows you to reduce treatment times from 6 to 9 months down o 3 to 5 months, essentially cutting treatment time in half. Since we performed immediate dental implant placement, this means that all four teeth were removed and the two dental implants were placed simultaneously.

After removing the teeth and placing the implants, the temporary denture is delivered.

Temporization

In this case, it is best NOT to load the teeth the same day if you are placing dental implants at the same time as extracting teeth. Loading the teeth immediately can lead to implant failure and is generally not recommended in a case such as this. The patient was given a temporary denture. He will be wearing the denture for the next 3 to 4 months until the implants and extraction sockets heal. He was instructed to wear the denture as minimally as possible for the first few days. As the implants and extraction sockets heal, he can start to wear the denture more frequently. Strenuous exercises, hard foods and electric toothbrush is to be avoided for the first few weeks, possibly longer, depending on the healing time.

Restorative Plan

A four-unit dental bridge connected to two dental implant anchors. Again, placing individual dental implants in the lower anterior region is usually not possible due to lack of sufficient space. Consequently, we place two dental implants and then splint them via a bridge. Depending on where the bone settles down, we may have to use pink porcelain to replace the missing gum tissue. This is a restorative judgement which will be made at the end of treatment. It depends on should on where the gums settle and what looks best on the patient. In a big case such as this one, always be ready for some pink porcelain to fill in the defects. If you have a gummy smile and would like to avoid pink porcelain, talk to your doctor about this in advance. Be aware that additional surgeries may be required to avoid pink porcelain.

Conclusion

Dental implant technology has come a long way in the past few decades. The most important thing about placing dental implants is understanding how implants heal and where to place them. It is important to seek your implant treatment with a dentist who has lots of experience. Dr Jazayeri has been placing dental implants since graduating from NYU Implant Seminars back in 2008. He has successfully placed and restored over 2,500 dental implants. To book your complimentary implant consultation with us, click here.

Brush 'n Floss Yo Teeth!
Ali John Jazayeri, DDS