Maret 08, 2017
hi, i’m frank spear. i’d like to sharewith you a little bit of my motivation for writing an article on the challenges of replacingan adjacent central and lateral incisor. the truth is my motivation was very simple. myopinion? they’re the most difficult two teeth to replace there is and still achievean aesthetic result. the reason for that difficulty? trying to maintain soft tissue, especiallyif you use adjacent implants. this is an example, the left central incisor the left lateralincisor are two crowns they are both on adjacent implants. the challenge is maintaining thebone between the implants. this is shortly after those restorations were placed by avery good general dentist. here it is 12 months later, not the dentist’s fault, simply thebiology. the bone went away between the two
implants because of the proximity of the implantsin this particular site of a central and lateral. so in the article, i discuss why achievingan excellent papilla between adjacent implants is so difficult and i also provide some strategiesfor improving the likelihood of achieving an aesthetically acceptable result. some strategiesmay be things like doing a single implant and cantilevering the lateral incisor as anexample. one of the beauties of doing that is if you cantilever the lateral incisor,even if your soft tissue is not ideal, you can use pink ceramic to make up for the artof the missing soft tissue and its easily cleansable because you can floss under thepontic. if you use two adjacent implants and you have to use pink ceramic, far more difficultto be able to cleanse the implants because
of the difficulty of getting under the pinkceramic. this is just a simple example; this particular patient is going to lose both theleft central and the left lateral, untreatable endodontic problems. the challenge will beas those two teeth come out how do you maintain bone? how do you maintain soft tissue? here’sthe final result. the site was grafted after extraction, was soft tissue grafted. but evenwith all of that being done as you see in this photo the papilla between where the centraland lateral should be isn’t really ideal. but, because it’s a cantilevered lateralit’s possible to put a little bit of pink porcelain to make up for that papilla, veryeasily cleansable. in the article, i go through a number of other strategies besides thisstrategy such as fpds for example, from, in
this case, the right central to the left canineand talk about what those concerns would be as opposed to the implants. with that in mind,i hope you enjoy the article. i hope it provides food for thought for the next time a casecomes along in your practice where these two teeth in particular have to be removed. thanks.enjoy reading.
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