This week’s case involves a 27 yr old young man, named Henry, who was struck in the mouth at the age of 14 with a baseball bat. His lives in Venezuela and works as a physical therapist. This accident caused Henry to lose three front teeth, his upper right cuspid [eye tooth], lateral and central. In this case, bone damage was extensive. The entire ridge is lost in that area in a U-shaped manner, going all the way to his nasal cavity.
Henry’s Earlier Dental Treatments and Advice
His previous dentist did an excellent job by fabricating and placing a fixed bridge, which is double-abutted to the central and lateral and single-abutted to the #4, the upper left first bicuspid. Thus, three teeth were replaced with three natural teeth supporting the bridge, where a bridge encompasses a total of 6 teeth. Pontic replacing teeth #’s 6, 7 and 8 were very long to hide. However, Henry had a low lip line and that’s why the space where bone and gums were lost looked very natural. Henry sought treatment for dental implants in Houston because he was told by his dentist that tooth #4, which helped in holding his bridge in place, was hopelessly decayed and it would require extraction. He was advised that his only options were
1. A removable partial, or
2. A new fixed bridge, extending one tooth further back, or
3. Dental implants
Unfortunately, his dentist told him that dental implant is not possible because of excessive bone loss. He was further advised that in order to place another fixed bridge, another natural tooth would need to be cut down. In fact, the concerned dentist also warned Henry that there are high possibilities for him to lose another tooth in the future. Henry was advised that a partial denture can be an option but there too some issues might crop up, such as:
i) uncomfortable feeling due to dentures
ii) tooth decay and gum disease may occur in the places where the dentures are attached to natural teeth
All in all, Henry was not given a very attractive set of choices by his dentist.
Henry’s Search for the Best Dental Implants in USA
At this juncture, Henry got busy in calling his contacts in the States and researching the internet. A few days ago, he landed in my dental implant practice in Houston, Texas. Henry learned from his sources that we are the leading-most Houston implant surgeon and consequently help our patients to grow new bone in their upper and lower arches for the purpose of implant placement.
[Dental Implantology is the process of placing man-made roots in the mouth of the patients to replace natural roots and serve as attachment systems for one tooth to a full mouth of teeth.
Dental implant Prosthodontics is the art of building dental restorations on dental implants.]
Henry’s Case Study – Dental Condition, Dental Implant Challenge & Our Success
Henry’s case was very similar to that of other dental cases, caused from accidents. In most of these cases, we have witnessed that the patients face trauma at the front of their mouth. Teeth, bone, and gums are also found missing in these cases. Multiple remaining teeth with varying degrees of damage are also common in these patients. These are among the most challenging cases we face with dental implants because it is the front of the mouth and a stunning esthetic result is just as important as a comfortable, durable and functional result.
Fortunately, dental implants in Houston have come a long way and lately advances in bone regeneration techniques have flourished as well. Upon Henry’s return I began by removing his existing bridge, extracting hopeless tooth #5 and reflecting a full thickness flap from the mesial of tooth #3 to the mesial of tooth #6. As the CAT Scan had revealed, there was a very large midpalatine neurovascular bundle that would have produced a substantial Diasthema between 8 and 9, if both were naturally existing or if I placed an implant in the 9th position. The bundle was removed and the fossa was decorticated to a depth of 9mm to facilitate dental implant placement in that position at a later date. As the bundle tailed off, the lingual removal of only 9 mm was required. Much as in a traditional sinus lift, the nasal membranes were lifted slightly and bone was decorticated with numerous “punches” from a quarter round bur with copious irrigation. This was followed by the final shaping of a titanium mesh membrane and filling of the voids, including the incisive canal with “osteocell”. The mesh was secured with two palatal bone screws and two buccal bone tacks. Tissue was harvested from the palate for using it as a free gingival graft over the extraction site #5, where primary tension free closure was not possible. The surgical site was closed with gut. Tooth #4 was sacrificed to crown prep so that we could use a fixed temporary bridge during the bone regeneration stage. I find that grafts with membranes, titanium mesh or titanium reinforced Teflon, are much better when they are not molested by the pressure of removable appliances. The temporary bridge was secured and only one task remained. There was a small tear in the palate at the most apical mesial corner of the titanium mesh membrane. It was exactly over the head of the bone screw. To say the least, this was not a positive development, as exposure over the bone screw is common without a tear and it could lead to infection and a failed grafting procedure. I made every attempt to close the tear with sutures but was less than completely successful. A very thin suck-down clear plastic stent was formed and the patient was asked to wear it 24x7, except for those cases where it needed to be removed for cleaning purposes.
It is possible that this very small error could jeopardize what was otherwise a beautifully executed surgery. However, God Willing, and with a little bit of luck, we have laid the foundation for giving back Henry a second chance for a beautiful, naturally functioning set of front teeth.
I’ll keep you informed about this unique case of Henry in our center of dental implants in Houston.