Prosthodontic Solutions

When an implant fails - early or late - it is very rarely as simple as 'graft and try again.'

Here is a good example of that. By the time this patient was referred to me there had been two failed implants (both early failures) and an additional failed grafting procedure. Not only is the edentulous site completed destroyed, but the adjacent teeth are severely damaged as well.

All the while, the treating surgeon saw tooth #24 was already crowned (poorly I'd add). This case should have been treated with a fixed partial denture from the get-go. Mandibular incisor sites are almost never candidates for a dental implant (in a partially dentate situation). It is nearly impossible to meet the anatomic space constraints of these narrow teeth. With the success rates of bonded restorations and FPDs, taking on these anatomic risks with implant therapy is not logical.

The challenge in treating this site now is the difficult pontic site. The horizontal defect is only partially visible in the clinical photographs. A provisional (shown in image 3) is used to train the patient on oral hygiene around the susceptible root surfaces. Due to the extent and volume of recent surgery, further surgical modification of this site was not an option at this time. This compromise is acceptable compared with extraction options and managing a larger edentulous area. Fortunately, this patient is fairly caries resistant.

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