These days we are always in a hurry. We are being pulled in hundreds of directions: family, work, spouse, friends, Christmas shopping, and then… you break your front tooth! Then you see your dentist and you are told about something called a flipper (funny because it’s nothing related to a swimming animal), and your eye rolls when you find out that the tooth needs to be removed and grafted, wait for 3 months of socket healing, have an implant placed at your favorite local oral surgeon in Los Alamitos, wait four months for bony integration of the implant to bone, and then have your dentist restore the implant over a 2-3 week process. We have a hard time waiting to finish the drive home before texting or checking your emails, so how can we expect patients to wait over 8 months to get a new tooth while wearing a flipper this whole time?
Well, the conservative method is tried and true, backed with research and data leading to a very high success rates. But can we, as oral surgeons, save time for our patients? Besides saving time, there is also the added benefit of tissue preservation. When you smile you see two pink triangles on either side of your front teeth. These precious little pink triangles actually need bone to support the base. There is very good data that once a tooth is removed the bone around the tooth withers away, and thus does the support for the gingiva to form nice healthy pink triangles. We minimize this effect by grafting bone into extraction sockets to preserve the bony architecture, and we can also change the tissue quality by grafting connective tissue to plump these little triangles that we call dental papillae.
Another technique is never allowing the bone or soft tissue to lose support during the extraction phase. How can this be done? Replace a broken tooth immediately with another tooth, and thus preserve the anatomy to prevent bone and tissue loss. In one appointment, a tooth can be removed, an implant placed, and an implant supported temporary crown can be screwed into the dental implant. Overall the 8 month process takes 5 months instead, and during the 4 months it takes for the dental implant to integrate to your bone, you will have a naturally appearing and feeling temporary crown that is supported by the implant. Your friends and family won’t even know you had your front tooth removed.
In all advanced surgical cases it is about case selection. For this method you need an ideal patient, an ideal surgical experience, and an ideal implant. I won’t belabor the ideal implant, and I’m assuming all of our patients at Alamitos Oral Surgery will be receiving ideal surgery, so why do we need an ideal patient? This is important because if an implant is placed and a temporary crown is placed immediately at the beginning of the 4 month healing phase, we ask our patients not to bite into their food to prevent forces that will prevent an implant from integrating to the bone. These temporary crowns are actually made subtly short to prevent any contact on this tooth at any time.
In my experience, single rooted teeth without risk of heavy contact during biting and chewing, and without an acute infection are candidates. In addition, a close preoperative exam must show that the eggshell of bone on the entire outside of a tooth must be present before this attempted method. This can be confirmed by taking a quick dental CT in our office to show the 3D architecture. This ensures ideal esthetic results in the long run. There is very good data that if this buccal (outer side) bone is not present for an immediate implant placement and immediate temporization after an extraction, then metallic show of the implant can occur down the road, which is disastrous. Sometimes this is compromised by the trauma that injured the tooth, or from the infection of the tooth that led to the extraction, and so this method can not be used. This thin shell of bone may also be lost during the surgery in the hands on an inexperienced surgeon, and so this method must be aborted.
We often ask your dentist to fabricate a “flipper” or stay plate in the event of the implant can’t be placed or if the implant can’t be temporized immediately. This may be because of surgeon preference to have a lab make the temporary after the implant is placed, which requires a 5 day turn around time. In order for the temporary to be placed at the time of the implant surgery instead of the 5 day wait, the temporary will have to be made at chair side by your surgeon, or would require fabrication ahead of time. For the latter method, this would require guided surgery with a surgical guide designed and fabricated with the aid of our in office dental CT and virtual surgical planning.
At Alamitos Oral Surgery, our surgeons are on the cutting edge of implant surgical techniques. However, we only believe in providing the ideal surgical technique uniquely catered to each patient and to his or her presenting situation. This is determined by a thorough exam and consultation, aided by our in office dental CT. We will partner up with your restorative dentist to help you get to that perfect smile.
Lee D. Pham, DDS, MD, MS
Diplomate, American Board of Oral and Maxillofacial Surgery