Implants for missing tooth/teeth or close space(s)

One or more teeth are missing. What can be done?

Implants or close space?

 

General rule:

In the long terme, no implant will ever be better than a natural tooth.

Whenever possible avoid implants in the anterior region in young adults.

 

Decision depends of the orthodontic possibilities, if the missing tooth is anterior or posterior and the number of missing teeth.

Un implant n'est pas posé avant 19 - 20 ans. Mieux après 30 ans.

With a life expectancy of 80years, an implant will stay in the mouth for 60years!

It is a controversial subject. You will find here good examples and explanations. Then it is a matter of common sens.

A/ Missing anterior teeth in a young adult: The upper lateral incisors are missing which explains the gap between the central incisors.

Treatment plan: Close the gap between the incisors. Advance the right canine and change it into a lateral incisor. Leave space for canine implant. Close the gap between the centrals. Move back the left canine to open space for lateral incisor implant.  Insert implants as right canine and left lateral incisor. No treatment in lower jaw. (This treatment has not been  done in the practice of  Dr Dahlquist):

Result:

Why is the result disappointing? The shade of the crowns is not good. The implants are visible trough the gingiva (gray shade) and the implant structure is visible on the right canine. Above and below.

Can it be improved?

The shade of the crowns (blue dot) : easy, change them.

Gray line (blue line) : difficult or impossible. Gingival graft?. The implant should be lower in the bone. Cannot be lowered.

Gray shade in the gingiva (blue dashes) : impossible to correct. The implants have not been inserted deep enough in the bone. Visible by transparency.

 

One result is perfect: The canine (green dot) has been moved forward and composite has been added to make it look like a lateral incisor.

The most important is that the gingiva will always be adapted to the tooth. There will never be the possibility that a metallic part becomes visible like with an implant.

Conclusion is easy:

Whenever possible, anterior implants are avoided in the young adult.

B/ Middle aged adult:

Two crowns have been inserted many years ago. Teeth change color with time. The actual colors don't fit anymore.

There is a bone loss with loss of gingiva. It would have been an implant, it would be visible like here: 

The root is short and there is little bone. Tooth is lost.

Treatment plan:

1/Extrusion(elongate) the incisor because the bone elongates as well(green arrow). This allows an optimal implant insertion.

2/ Implants inserted and crowns.

Final result. Compare with above.

Prosthetic replacement: Dr Dietschi, Geneva Smile Center

Conclusion: In the adult, especially after 30, anterior implants are a very good solution

C/ Substitution in the teenager: The tooth next to the gap has been moved into the space of the lost or missing tooth.

 

Example: Lateral incisors are missing. The canines have been moved in. No implant, no bridge.

Other example: upper left lateral incisor is missing. Left canine has been moved into the space (green dot).Right lateral incisor (blue dot) is in place. Difference is almost nil.

No implant, no bridge.

Missing upper central incisor: This young patient lost his tooth in an accident. The lateral incisor has been moved into place and composite has been added to make it look like a central incisor. The canine is used as a lateral incisor.

The composite will need to be changed if it breaks or the color alters.

No implant. No bridge.

D/ Missing teeth in the posterior region in the teenager:

This patient has the lower second premolar missing under the baby molars (red dot). The teeth cannot be kept: ankylosis, decay, poor roots. The lower wisdom teeth have no space to erupt (green dot).

 

Treatment plan: Extract baby teeth, move posterior teeth forward

 

Advantages: No bridge, no implant. No wisdom tooth extraction.

Final result:

Above: Spaces closed. Wisdom teeth erupt normally.

Belove: Good occlusion with nice smile.

No implant no bridge no wisdom tooth extraction. No problems in the future.

 

Same patient:

Conclusion: Whenever an orthodontic treatment is planned in the situation of missing teeth, space closure should be favorised.

To close spaces orthodontically when an orthodontic treatment is otherwise not needed, benefits and disadvantages have to be evaluated.

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