So Why Did the Cuspid Fracture and Where Do We Go From Here?
Another general dentist referred this patient to me when he noted that none of the molars contacted. The 64 year old patient was experiencing pain in the maxillary right cuspid and endodontic therapy was begun. The patient could not be made comfortable and it was determined that the tooth was fractured.
My question to the group would be: "Is it acceptable to place an implant into position #6?
My answer would be:"NO!"
Why did #6 fracture?
1. The patient has no posterior occlusion and #6 was functioning as a primary chewing tooth.
2. The maxillary anterior teeth are in the zone of function and should be moved labially and out of harms way.
Will you place an implant in harms way without correcting the occlusion?
What am I thinking?
1. The patient was referred to the orthodontist but he refused to treat given the loss of bone on the maxillary left molars (Note the palatal recession.)
2. Orthognathic surgery in a 64 year old is not probable.
3. I contacted the orthodontist and proposed that we should extract the left maxillary molars with less than 50% bone support and place implants in a more palatal position in the arch to create posterior contact. I also thought that LO inlays could be placed in the maxillary right two molars and BO inlays placed on the mandibular right molars in an effort to obtain maxillary contact.If this approach was followed, would the orthodontist agree to move the maxillary anterior teeth labially to improve the overbite/overjet issues? He agreed to perform limited orthodontic therapy.
(This case is better viewed on models than as clinical photos)
I am presenting this case because we have had recent discussions about cases where the occlusion had a significant impact on loss of a tooth but many here thought that an implant could safely be placed. If the patient lacks the financial resources is it acceptable to place an implant into position #6 without providing posterior support?