Amanda came to see us with what most people are afraid of. Her front tooth was loose! And she sensed that she might lose it.
When I examined her, it was confirmed her front incisor had a fracture and could not be saved. We presented her with the option of extracting the tooth and replacement with a single dental implant. A dental implant is shaped similar to the root of a tooth and its titanium surface enables the growth of bone forming cells that help to anchor the implant to bone. We explained how we can attach a crown component to the implant and this can be made to look very similar to her natural tooth.
Even though she was nervous at start, she was willing to go ahead with our recommendations. Her dad had been through a similar procedure with a good outcome and this helped to reassure her.
So we began the treatment first by carefully removing the cracked tooth and doing a bone graft to preserve the remaining bone. Socket preservation bone graft is a very valuable procedure using bioengineered bone matrix to induce the growth and formation of new bone where a tooth is lost or where a bony defect is noted. This enables us to have a stable foundation to place the dental implant n the future. Amanda tolerated this first very important stage of treatment very well and needed nothing more that local anesthesia for the procedure. We used her natural tooth as a temporary replacement by bonding it to her adjacent teeth, a technique called direct tooth pontic and we did this immediately after the extraction so that she would never have to be without her front tooth.
Following this we waited patiently for bone and tissue healing. This healing time usually takes about 4 months during which we would see her bi weekly or monthly to monitor the stages of healing. There were times when we needed to repair her direct tooth pontic but Amanda was very patient during all this time.
In the summer of 2016, we began planning to place the dental implant. A Cone Beam CT (CBCT) scan was done which allowed us to plan the direction and position of the implant with the bone. CBCT is another valuable innovation in implatology today that allows precise planning and identifies potential risks that we could encounter during surgery. In her case it was an enlarged incisive canal, which is a collection of nerves and blood vessels close to the site of surgery. Using information from the scan, we were safely able to stay away from that area.
The implant surgery was successful but we still needed to wait for another 3 months for the implant to be firmly anchored into bone.
Finally it was time for us to fabricate the final crown. This process involves making an impression which is an imprint of the implant which enables our dental laboratory to design the permanent crown. Today this is done using CAD-CAM milling technology. We used custom staining to give us the color and the hue to blend with her smile.
We were all pleased with the final result, especially Amanda who could not stop smiling.
Amanda was always patient and supportive throughout this journey. She works hard as a veterinary assistant and recently had the opportunity to go on a mission trip to Guatemala to save the lives of many animals and to spread smiles. To learn more about the great work that Amanda and other vets around the world are doing please check them out at http://www.arcasguatemala.org/donors/how-can-i-help/
We wish her the very best and continued success in her chosen path. Keep smiling Amanda!