Patient Showcase ~ Sarah

The restoration of a single tooth in the esthetic zone can be one of the most challenging procedures in dentistry.  The restoration of a missing tooth in the esthetic zone is not only challenging but compounded by soft tissue demands.  The challenge in both cases involves restoring a clinical crown that mirrors the contra lateral tooth. To achieve lifelike esthetics when there is a missing tooth or tooth to be lost, soft tissue management becomes paramount.

Sarah is a healthy, married female with two children. Her chief complaint was her front tooth has a crack in it and she is afraid she may lose it. She reported that this tooth has had at least two root canals and a surgery done on the end of the root. Visually the upper left central incisor was darker than the upper right central. The vertical crack was very apparent from tooth’s incisal edge to the gum on both the front and back sides.

The diagnosis is vertical tooth fracture based on the clinical appearance and x-ray findings.  A discussion with the patient included the unknown extent of the vertical fracture up the root of her tooth.  An option to crown the tooth may stop the fracture from progressing, but if the progression was already up the root the tooth may still be lost.  An option to remove the tooth and replace it with a bridge would also eliminate the space between her front teeth, but create a tooth width to length ratio worse than what is already present. Our patient did not have a problem with the space between her two front teeth, nor did she have a problem with the existing size or shape of her front teeth.

Replacing the tooth with an implant and crown was most appealing to our patient. The attention for our patient now became “how soon do I get a tooth when this one is removed?” My attention now became how to best preserve the tissue contours. I presented the patient with the treatment option of immediate implant placement with immediate temporary crown placement.

This Accreditation case demonstrates an esthetic tooth replacement option where an implant is the best solution. The immediate implant placement with immediate temporary abutment and transitional crown maintained all tissue contours. The implant option also eliminated the need to destroy tooth structure on adjacent, perfectly healthy teeth. .

The implant crown preserved the patient’s crown shape and contours as well as the space between her central incisors.  This patient developed an acute appreciation for every aspect of the replacement process and is very pleased with how natural this “tooth” looks and feels.  Fellow employees as well as family have asked, “Which tooth was it”?  She knows well that “we” got it right.