Single Tooth Implant

Under ideal conditions, replacing posterior (back) teeth with dental implants is a straightforward process. As an experienced Dental Implantologist, Dr. Andrews recommends to start planning for a tooth replacement with a dental implant before the tooth is extracted.

The reason is simple – the bone is widest around natural roots of the teeth. Without appropriate planning after an extraction, around 50% of the bone volume is lost within 4-6 months, usually in horizontal dimension. If there is not enough bone, it has to be added with a procedure called Bone Graft. In addition, natural teeth and supporting tissues near where the implant will be placed must be healthy.

​The shortest treatment time for a complete implant (including surgeries and placing the permanent crown) is about five months for lower jaw and six months for upper jaw. However, the process can last up to a year or more, particularly if bone needs to be built up first. In 85% of his cases, Dr. Andrews is able to extract the tooth, perform bone graft (if necessary) and place an implant at the same time in a single visit.

This patient came to see Dr. Andrews in our Boston Dental Practice with the desire to replace her missing lower left molar (#19). Since the extraction was done more than a year prior to the visit, more than 50% of the bone volume was lost. Being the second biggest tooth in the mouth, a lower molar requires a strong foundation to be built on.

Studies confirmed, that for long-term success, an implant diameter for such case should be no less than 5 mm. With only 3 mm width of the bone available here, no implant can be placed without a bone graft. The classic (old) treatment planning dictates the two-stage approach. The bone graft (ridge augmentation) is done first. After 4-5 months, when the bony ridge is wide enough (10-12 mm), an implant is placed. Then another 5-6 months are required for the implant to integrate with the bone. Add another month to make a crown. Thus, the total treatment time is 10-12 months.

Using modern, advanced surgical techniques, combined with PRF protocol, Dr. Andrews was able to combine bone graft with the simultaneous implant placement. He augmented the bone ridge wide enough to place 7 mm implant diameter. That is 200% more implant-to-bone surface area compared to a 5 mm one. Such a strong foundation should be able to support the implant crown for the entire patient’s life. This case took Dr. Andrews 5 months to complete, with only one surgery.

One of the biggest challenges in Dental Implantology is the replacement of the upper central incisor. ​These CT-scan cross sections of the front upper teeth demonstrate normal anatomical features, which make the job of Dental Implantologist very difficult:

• Paper-thin alveolar bone around the roots of the teeth
• Angulated 15-20 degree long axis of the tooth
• Long anatomical crown (increased lateral load on the future implant compared to the back teeth)
• 4-5 mm overbite (overlap with the lower teeth)​

Besides the surgical challenges, there are also the cosmetic ones. Upper central incisors anatomy makes up to 85% of your smile. Dr. Andrews has to make a new implant crown to match another tooth in shape, texture, volume, shade and translucency, among other factors.

A graduate student came to our DENTOLOGY practice with a broken upper front tooth. Dr. Andrews recommended to replace it with a dental implant. Due to high smile line and anatomy of the area, this type of cases is considered to be one of the most challenging for a dentist to treat.

Without any incisions, Dr. Andrews removed the broken root and placed an implant along with a bone graft during the same surgery. Immediately, a temporary crown was attached to two other front upper teeth to form the ideal shape for the soft tissue profile. A few months later, 3D Intraoral scan was taken and Dr. Andrews used Virtual Prosthodontics (CAD) and Reverse Restorative Rehabilitation Protocol to design Full Contour Zirconia (FCZ) screw-retained Implant Crown.

Then the crown was milled (CAM) and sintered by a specialized Milling Center. Once it had been received, the FCZ restoration had been custom shaded and glazed at DENTOLOGY in-house lab. During the patient’s next and final visit, all-ceramic crown was delivered via screw-retained fashion to prevent any complications associated with cement retention under the gum margin (the most common reason for implant failures in intraorally cemented cases).