Why Do We Need Bone Graft for dental implants? Case Study

When we lose teeth we also inevitably lose bone. The loss of bone is more pronounced on the focal aspect rather than on the tongue side.

The problem is that most front teeth are positioned on the facial aspect that makes your smile appear natural

This is ok when you have a low smile line that is when you smile you don’t show your gums.

However when you have a high smile line (gums showing) then we can have problems with aesthetic outcome and refer this situation as an aesthetic risk assessment.

You see implants are not teeth. Teeth have taken millions of years to be evolved. Implants are artificial devises that we place in the bone and allow integration.

Therefore it is essential to place implant in correct 3 D in the bone to allow natural tooth emerging through the gums. This is most difficult even for experienced specialists; however we all do our best to make it look right

Ms. E. was referred by her sister existing patient for specialist evaluation. After attending her general dental practitioner, Ms. E presented with recently extracted upper right first premolar. The extraction was traumatic and unfortunately the facial bone was removed at the same time. The dentist unfortunately with minimal experience trying to provide provisional bridgework unnecessarily cut good adjacent two teeth.

I summary we have the following problems;

1. Loss of biology- ruthlessly cutting unrestored healthy teeth! Tooth 13 upper right canine tooth is now symptomatic!
   this is indefensible
2. Traumatic extraction: loss f large chunk of facial bone causing horizontal and vertical defects
3. High smile line with large facial defect
4. Traumatisedapprehensive patient!

This dentist should have sought a specialist opinion prior to extraction of tooth 14. As specialists we are trained in atraumatic extraction and know how to make non invasive provisional bridgework. The ignorance and arrogance of inexperienced dentists is a concern that all specialists and experienced general dentists share.

High smile line: The defect is clearly visible and most upsetting for this post graduate university lecturer and practicing lawyer.

How do we fix this problem?

Treatment: 3D planning using CBCT (cone beam Ct) and diagnostic planning that included

1. Extent grafting required and 3D implant position
2. Providing improved provisional bridgework to restore Ms. E’s confidence and reduce apprehension

This study will show

• Complexity of treatment. Hence specialist intervention is required as precise outcome is critical
• Treatment outcome
• Patient’s assessment
• Please refer to the video provided