This case is a great example of the benefits of a great dental team. I worked closely with the patient, the orthodontist, and the periodontist to achieve a great result that will last a long time.
One of my patients had a baby upper canine that stayed in place for around 30 years too long. Eventually, the tooth developed decay that was too extensive to repair and we started to discuss options to replace the tooth.
Following the evaluation of options, the patient decided that they wanted an implant and crown to replace the baby tooth.
We just had 2 problems: space for the crown and space for the implant. To place the implant, the roots of the two adjacent teeth needed to be tipped out of the way. To produce a crown (and final smile) with appropriate proportions, the finished crown needed to be larger than the existing baby tooth.
We had two options for generating the space needed for the implant and the crown: 1) orthodontics to move the teeth into the proper positions; 2) placing crowns and veneers on many of the front teeth to give the appearance of teeth with ideal proportions and proper spacing across the smile.
The patient was evaluated by both the orthodontist (for braces) and the periodontist (for implant placement) and decided to proceed with braces instead of placing additional crowns and veneers. For most of her treatment in braces, the orthodontist used a plastic tooth cemented to a bracket at the open space so that the patient did not appear to be missing a tooth. I kept in close communication with both the orthodontist and the periodontist regarding how much space was needed for each of us to perform procedures that would be likely to work, look great, and last long-term.
Above: The patient near the end of orthodontic treatment. The implant has been placed and she is waiting for the braces to finish moving the teeth into ideal positions.
When the patient was nearly finished with braces, the implant was placed and the orthodontic treatment was finished while the bone integrated into the implant. After braces were removed, the patient wore a retainer (again with a plastic tooth in it to hide the space) for a period of time to allow the teeth to stabilize and tighten and then I placed the crown on the implant to finish the treatment.
Above: Implant placement. The orthodontist was able to provide just enough space for the periodontist to place the implant between the two natural teeth. Prior to the orthodontic movement, the roots of the natural teeth were tipped toward each other, making implant placement impossible.
Interdisciplinary treatment like this would not be possible without a network of skilled specialists who understand dentistry outside their area of expertise and are willing to discuss objectives and treatment outcomes with a general dentist like myself. My selection to 5280’s Top Dentist list by local specialists is meaningful to me because it’s a public acknowledgement of my thorough treatment planning, ability to intelligently and effectively communicate treatment needs, and finish cases like this successfully.
Unfortunately, I did not take photos to illustrate the position or condition of the baby tooth while it was still in place, but the following photographs demonstrate the final position of the teeth and the appearance of the final crown.
Above: following completion of orthodontics, before placement of the final crown.
Above: The final crown in place.