Factors in the failure of a left lateral incisor implant with significant bone loss and tissue recession.

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Posted on 01.17.2012 01:16 PM By Maurice Salama In Failures

Please let me know your thoughts regarding this patient who came to me after failure of a previously placed dental implant in the area of the Maxillary Left Central Incisor. There has been substantial bone and tissue recession including the mesial of the Left lateral incisor. How would you treatment plan this case?

thanks Dr. Salama

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6 Comments

fadie khoury says on 01.18.2012 06:11 PM

Hi Maurice,
what about the mobility of tooth 22(10) and the probing depth ?
This is a type 3 defect that we should plan carefully.

Sam Busich says on 01.19.2012 07:01 PM

Tough situation. Mobility of Lateral incisor? Extract? Root Submergence with soft tissue augmentation? Conventional bridge. Just a thought. Can you post a CT image?
Sam

Maurice Salama says on 01.20.2012 07:56 AM

Thanks Fadie and Sam; Yes, very difficult case. It is a Class 3 Defect and yes the lateral is 1+ mobile. The patient is considering a bridge or implants? We need to advise her as treatment has not been initiated. Do we extract the lateral right away? 1 implant or 2?
Dr. Salama

Bruce Fine says on 01.30.2012 09:00 AM

Hi Maurice,

Without more information, it's difficult to come up with a treatment plan. One idea may be to supererupt the lateral to improve/reestablish proper soft/hard tissue contours around the lateral which should make it easier to reestablish the soft tissue contours in the area of the missing central. Then remove both teeth and place implant(s) depending on the space. What are your thoughts?

Lotta Carmelo860 says on 02.05.2012 07:21 AM

if we want a implant restoration the first problem is the bone loss at mesial of 2.2.
the ideal treatemten possible is
-extrusion of 2.2
-gbr at 2.1
-STR at 2.2 (the space mesial-distal is not ideal for two implants
-one implant at 2.1 that supported 2 crown 2.1 2.2
It a complex case and higt difficulty

Jeffrey Sims says on 02.15.2012 08:15 PM

Has occlusion played a roll here? Flat canine, guidance issues to keep the lateral mobile?? I'm not sure extrusion will help much with the lateral. If the distal bone of #10 is good, how much can you get on the mesial by extrusion? Would that even work Maurice? This may be stupid, but what is the large radiolucency above the central? Palatal cyst? I've seen your office due wonders Maurice, but perhaps a bridge with pink ceramics after tissue augmentation of the pontic area? I don't see how you could get more bone on the mesial of the good central by grafting and if you move the tissue during implant surgery, won't you loose it due to the loss of the mesial bone? What are the wishes of the patient?
Interesting case and look forward to the progression of this case.