Patients often present to our practices with limited information about tooth replacement, most of which is gleaned from situations evaluated on the internet. In these moments, practitioners are provided with the opportunity to communicate options for treatment and discuss prognoses and long-term viability. Being able to visualize a final result prior to any surgical intervention is an advantage promoted by the use of modern diagnostic tools, such as cone-beam computed tomography (CBCT) analysis. By explaining what is possible to patients, they are enabled to become an integral part of the decision-making process.
Implant dentistry has become mainstream. Confidence and competence in communication and clinical training in anatomy, diagnosis, treatment planning, and the nuances of the surgical and prosthetic applications is essential to truly provide patients with an excellent service that restores function and esthetics. Each of these components is equally important when incorporating implant dentistry into a practice.
The concepts of smile design and emergence profile development are taken seriously in today's clinical settings. Because patients' expectations are high, achieving acceptance and success takes careful planning and a clear understanding of all of the processes. A prosthetically driven approach to planning is best when determining the ideal positioning of any implant. Designing the tooth replacement first results in better surgical placement and minimizes prosthetic complications.
In this case, the patient presented with a symptomatic mandibular left first molar (tooth No. 19) that had previously undergone endodontic treatment and restoration. Following an endodontic consultation, the tooth was deemed non-restorable, and the patient was informed that it would need to be removed. Options for treatment were presented, which included leaving the space edentulous, fabricating a single tooth removable appliance, preparing the site for a three-unit conventional fixed bridge, or delivering a single tooth implant-supported restoration. A good-better-best approach was used during the treatment presentation, with implant placement certainly being considered the best option. The replacement of missing teeth is always preferred to leaving a space in order to improve function and prevent other complications. After a discussion, the patient elected to have an implant placed.
The extraction of endodontically treated teeth with divergent roots can be challenging. Maintaining the facial plate minimizes bone loss and simplifies the grafting procedures of socket sites. In this case, after the tooth was extracted and the socket was grafted, bone turnover occurred in a short amount of time, providing the opportunity to ideally place the implant in both the mesial-distal and buccal-lingual dimensions. This is imperative for the development of a proper emergence profile. Because grafting is a critical component of dental implant therapy, being able to predictably grow bone should be within the implant dentist's wheelhouse.
It is essential to explain the use of modern dental techniques and technologies to individuals who present to our practices. These patients rely on our experience and professional judgement. Meeting perceived expectations is not always easy, but the more patients understand about what can and cannot be achieved, the more satisfied they will be with their end results.
About the Authors
Timothy Kosinski, DDS
Master
Academy of General Dentistry
Diplomate
International Congress of Oral Implantologists
Affiliated Adjunct Clinical Professor
University of Detroit Mercy
School of Dentistry
Detroit, Michigan
Private Practice
Bingham Farms, Michigan
Stephanie Tilley, DMD
Fellow
International College of Dentists
Fellow
International Congress of Oral Implantologists
Private Practice
Pensacola, Florida
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Timothy Kosinski, DDS
