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Creating Bone For Implant Placement

Lack of adequate bone at a desired implant site.


                        A partial denture replaces a front tooth missing since birth.


When a permanent tooth is missing it also means the bone needed to support that tooth is also missing.  You can see the concave area where bone did not form.

 Congenitally missing teeth often result in inadequate bone for implant placement.  In order to create an esthetic prosthetic result the implant must be positioned correctly.


Rebuilding the bone necessary for implant placement.


Block grafting is a technique that can rebuild the bone in a deficient area so that an implant can be positioned properly so that the most esthetic result can be achieved.

 The bone in this case was obtained from a tissue bank.  It was prepared to fit into the defective site and secured with a fixation screw.  The block was then covered with particulate bone granules and the entire complex covered with a barrier to protect it during healing.


Adequate bone and ideal implant placement.


                    With adequate bone the implant can now be placed ideally.

Once the bone graft has healed which usually takes 5-6 months the area is re-entered.  As you can see there is no longer a concavity but adequate bone for proper implant placement.  The implant is placed and covered up to heal for an additional 4 months.




Uncovering and tissue contouring with a healing collar.


                                  Contouring the tissue with a healing collar.

After the healing or integration period the top of the implant is exposed and a healing collar placed.  The purpose of the healing collar is to allow the tissues to develop a contour similar to that around a natural tooth.  This tissue contouring will greatly enhance the esthetic result.


The prosthetic phase of treatment.


           Abutment placement, crown cementation and restoration of esthetics.

Once the proper contour of the tissue has been achieved an abutment on which the crown will be cemented is placed into the implant.  An impression of the abutment is made and sent to the laboratory so that a custom crown can be constructed.  The crown is then cemented on to the abutment.


In order to achieve the best possible esthetic result you just don't replace teeth.  You need to have the supporting bony structure, gingival contours and drape of the tissue.  Otherwise it is like having a beautiful picture in a lousy picture frame.  No matter how good the crown is if the bony and gingival environments are not right it will not be esthetic and everyone will know it!


Replacing a tooth that was extracted years ago.


             Note the concavity caused by bone loss associated with an extraction.

The loss of a back tooth can severely compromise your ability to chew! 

After a tooth is extracted the bone that supported the tooth is lost.  This loss can be as much as 6 mm and 50% of this loss will occur in the first three months after the extraction.  The longer it is out the more the bone will be lost.  This results in a lack of adequate bone width for proper implant placement.


Rebuilding the necessary bone for proper implant placement.


This patient wants her ability to chew on this side restored with an implant support crown.  To accomplish this a block graft was done.  The material for the graft comes from a tissue bank it is shaped to fit into the defective area and stabilized with fixation screws.  The graft is covered with bony granules and a barrier to protect it during the healing phase.


Adequate bone now present for implant placement.



Once the bone has healed an implant can be placed in the proper position.  In some cases like this one a healing collar can be placed and the tissue allowed to heal around it.  This will eliminate the need for a second surgical procedure to uncover the implant.

This case is still in the healing stages. Once integration occurs, the abutment and crown will be placed.  Pictures of this stage will be posted in the future as treatment progresses.


Placement of the abutment.

Once the tissue has matured around the healing collar it is removed and the abutment screwed into the implant.  The abutment is the part on which the new crown (tooth) will be cemented.  Once the abutment has been placed the patient is sent back to their dentist to have an impression taken to fabricate the new crown.  

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