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 Table of Contents  
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 116-119

Replacement of missing central incisor with single implant-supported fixed prosthesis

1 Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Maxillofacial Prosthodontics and Implantology, RajaRajeshwari Dental College, Bengaluru, Karnataka, India
3 Department of Maxillofacial Prosthodontics and Implantology, Nanded Rural Dental College and Research Centre, Nanded, Maharashtra, India
4 Department of Maxillofacial Prosthodontics and Implantology, Gitam Dental College, Visakhapatnam, Andhra Pradesh, India

Date of Submission29-Oct-2016
Date of Acceptance14-Dec-2016
Date of Web Publication13-Jan-2017

Correspondence Address:
Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2455-3069.198383

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Loss of a single anterior tooth causes a major functional and aesthetic concern to the patient. There are different treatment options available for replacing a missing incisor. If the economic status of the patient permits, it is the responsibility of the clinician to explain the benefits of dental implant to replace a single missing tooth. This case report describes the replacement of a missing maxillary left central incisor tooth of a patient with dental implants for better function and esthtics.

Keywords: Central incisor, dental implants, missing tooth, single-tooth implant

How to cite this article:
Mishra SK, Chowdhary R, Patil PS, Rao SB. Replacement of missing central incisor with single implant-supported fixed prosthesis. J Curr Res Sci Med 2016;2:116-9

How to cite this URL:
Mishra SK, Chowdhary R, Patil PS, Rao SB. Replacement of missing central incisor with single implant-supported fixed prosthesis. J Curr Res Sci Med [serial online] 2016 [cited 2023 May 29];2:116-9. Available from: https://www.jcrsmed.org/text.asp?2016/2/2/116/198383

  Introduction Top

The common reason for tooth loss in anterior region is due to traumatic injury or congenital anomaly. There are two treatment options that exist for replacing missing incisors. They include a tooth-supported restoration or a single-tooth implant.[1] Due to the considerable advantages over the other treatment options available, dental implants are considered as a first treatment choice for the replacement of missing teeth.[2] The replacement of teeth by implants is usually restricted to patients with completed craniofacial growth.[3]

Branemark stated that there should be a period of at least 4–6 months before any restoration can be planned. Among the loading protocols, conventional loading is a predictable and an accepted treatment modality.[4] Considering the economic status and esthetic demands of the patient to replace single missing tooth, dental implants seems to be a good treatment option. This case report presents step by step procedure for the replacement a missing maxillary left central incisor with implant-supported fixed prosthesis to improve the esthetics and phonetics demand of the patient.

  Case Report Top

A male patient aged 45 years, reported with missing left maxillary central incisor to Department of Prosthodontics, HKE'S SN Institute of Dental Sciences, Gulbarga, Karnataka, India for the replacement of his missing tooth [Figure 1]. The patient gives a history of tooth loss 1 year back due to mobility of the tooth. Clinical examination was done followed by radiographic evaluation. On intraoral examination, it was revealed that there was missing left maxillary central incisor. Radiograph showed favourable amount of bone present and there was the absence of any underlying pathology. Maxillary and mandibular arch diagnostic impressions were made and diagnostic casts were obtained. A thorough medical history was taken along with complete haemogram to rule out any presence of systemic disease. The treatment options available for replacement of missing central incisor were removable partial denture, fixed partial denture, resin bonded bridge, and implant-supported fixed prosthesis. The treatment options available were explained to the patient in detail. The patient had given his consent for replacement of missing tooth with implant-supported fixed prosthesis. Bone mapping of the diagnostic cast was done for the site where implant was planned to be placed. Bone mapping revealed the labio-palatal cortical bone width to be 6.3 mm and mesiodistal length as 7.2 mm. An implant of diameter 4.2 mm and length of 12 mm was planned to place in the left maxillary central incisor region with two staged implant surgery protocol.
Figure 1: Missing left central incisor

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A preoperative antibiotic and analgesic therapy on the evening before the surgery and 3 days after surgery was given. The patient was prepared for the first staged surgery, and it was planned to place implant under local anesthesia with left infraorbital nerve block. The nerve block was given followed by incision to reflect the mucoperiosteal flap. The initial osteotomy was started with a pilot drill using a maxillary surgical stent for the correct implant position and gradually the site was enlarged in width and up to a depth of 12 mm. Once the implant site was prepared, an implant fixture of dimension 4.2 mm × 12 mm (Biohorizon, Birmingham, USA) was placed [Figure 2]. An intraoral periapical radiograph (IOPA) was taken to confirm the final position of the implant placed [Figure 3]. Implant cover screw was placed over the implant fixture, and flap was sutured back with 4.0 nonresorbable silk sutures. Postoperative instructions were given. The patient was called for recall check after every 2 weeks.
Figure 2: Implant placement in the left central incisor region

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Figure 3: Intraoral periapical radiograph showing implant in 21 region

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After 6 months the patient was recalled for second staged surgery for the prosthetic phase. An IOPA was taken to confirm the osseointegration of the implant placed. An incision was given over the implant fixture to slightly expose it and a healing abutment of size 3.5 mm × 3 mm was placed over the fixture. After 1 week the healing abutment was removed and a nice collar of gingiva surrounding the implant was observed [Figure 4]. The abutment was screwed to the implant fixture [Figure 5], and a closed tray impression was made with elastomeric impression material. The abutment was unscrewed from the implant fixture and positioned back into the impression along with implant analog [Figure 6] and the impression was poured in dental stone to obtain a master cast. Once the master cast was retrieved with the abutment, the milling of the abutment was done on the cast and rechecked by placing back in the patient's mouth [Figure 7]. The milled abutment was again placed back on the master cast and porcelain fused to metal (PFM) crown was fabricated over the milled abutment on the cast. Finally, the milled abutment was placed back and screwed to the implant fixture in patient's mouth and chair-side postoperative IOPA radiograph was taken to assess the complete seating of the milled abutment. The PFM crown was cemented on the abutment and patient's occlusion was checked, and the prosthesis was evaluated for esthetics and phonetics [Figure 8].
Figure 4: Gingival contour after removal of healing abutment

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Figure 5: Abutment screwed to implant fi xture for closed tray impression

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Figure 6: Abutment placed back along with implant analog in the impression

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Figure 7: Try in of the milled abutment

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Figure 8: Postoperative view of implant-supported single crown

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  Discussion Top

Replacement of missing tooth with fixed dental prosthesis although is a viable treatment alternative in different situations, but still dental implant restoration has definite advantages over them. The survival rates for the single-tooth replacement with implants was higher.[2] Replacement of missing tooth with titanium dental implants had provided a suitable treatment option for the patient. When conventional two-stage implant loading protocol was followed, implant stabilization during early stages of bone healing can be ensured.[5] When proper surgical protocols, along with the optimum implementation of restorative protocols and maintenance is followed, with periodic recall check, the survival rate of dental implant increased.[4] This case report also followed delayed loading protocol, and periodic recall check up to enhance the survival rate and esthetic of the patient. Immediate loading of oral implants is the commonly followed treatment protocol in implant dentistry today that increases the comfort of the patient, but the peri-implant bone response is poor in comparison to conventional loading protocol.[6] The loss of a tooth is followed by a major alveolar bone resorption, so to preserve the bone volume placement of implant is a valid treatment option available.[7]

  Conclusion Top

The replacement of missing tooth in anterior region can only be justified when the anticipated positive effects are greater than the drawbacks of the procedure. It is the responsibility of the clinician to explain the advantages of dental implants over other treatment options available so that patient can choose the restoration which is best for them.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Tuna H, Uzun G, Keyf F. The single-tooth implant treatment for maxillary central incisors loss after trauma: Case reports. Clin Dent Res 2011;35:47-52.  Back to cited text no. 1
Shenoy VK. Single tooth implants: Pretreatment considerations and pretreatment evaluation. J Interdiscip Dent 2012;2:149-57.  Back to cited text no. 2
Mishra SK, Chowdhary N, Chowdhary R. Dental implants in growing children. J Indian Soc Pedod Prev Dent 2013;31:3-9.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
Abichandani SJ, Nadiger R. Maxillary immediate implant loading: A comprehensive review. J Dent Implant 2013;3:52-7.  Back to cited text no. 4
  Medknow Journal  
Crespi R, Capparé P, Gherlone E, Romanos GE. Immediate versus delayed loading of dental implants placed in fresh extraction sockets in the maxillary esthetic zone: A clinical comparative study. Int J Oral Maxillofac Implants 2008;23:753-8.  Back to cited text no. 5
Ariano V, Mancini M, Cardi A, Condò R, Cerroni L, Pasquantonio G. Immediate nonfunctional loading of two single-maxillary postextractive implants: 6-year postloading results of two case reports. Case Rep Dent 2016;2016:1-7.  Back to cited text no. 6
Romanos G, Froum S, Hery C, Cho SC, Tarnow D. Survival rate of immediately vs. delayed loaded implants: Analysis of the current literature. J Oral Implantol 2010;36:315-24.  Back to cited text no. 7


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]

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