You Don’t Have To Leave Without a Front Tooth

Fractured root underneath an old crown

This Happened today……….

After Hearing The Bad News

It was determined that his tooth was hopelessly fractured. Unfixable. In fact, non restorable. With this in mind, all options for tooth replacement were discussed. The patient was adamant . He stated forcefully, “I do not want to leave here without a tooth and I do not want a flipper .”

The Plan

“Kill Two Birds with One Stone”

my Thought process

Foremost the best strategy, was to make the patient happy by fulfilling his expectations by the end of the visit. A fixed tooth in place was what he wanted. In this case, my plan was to extract the fractured tooth and simultaneously ,”fix the color” of his adjacent teeth.

That’s to say, we were going to do some cosmetic dentistry in addition to oral surgery today.

Ultimately, once the extraction site completely healed in several weeks, I would install the permanent restorations. To put in another way, a “3” unit ceramic bridge over the extraction site and two individual crowns of the adjacent teeth.

In short, kill two birds with one shot of anesthetic…….

The Flow of Today’s Appointment

“Firm in principle and Flexible in Procedure”

The Discussion

No Doubt, the tooth had to come out. By all means, it was fractured beyond repair. Absolutely, I would have loved to place an immediate implant, but the patient just wanted to leave with a tooth in place. An immediate implant to the site would have been a bit risky in the sense that, I could not guarantee that I would have been able to place an immediate crown on the implant on this same very visit. There are many factors that play on making the decision of immediate implant placement versus delayed implant placement. This was the best option for the patient because he wanted a definitive immediate tooth. In addition, he received a cosmetic benefit of all ceramic crowns on the adjacent teeth.

At the end of the visit, the patient went on to his very happy merry way with a fixed temporary bridge of a refreshing shade.
He will return in several weeks for a digital impression and subsequent final ceramic crowns. Today’s visit took on shot of Lidocaine and One Hour’s time.
pre-op.
Fractured lateral central incisor
Plastic temporary in place after extraction of fractured root
Close up of area with temporary in place

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your Friends:  robertemilioddsblog.wordpress.com

A Late Night Emergency. Ouch! The Split tooth.

Almost Gone……..

Notes for the day written up, jacket on, briskly heading out and almost at the exit door last night. “Where you going? Didn’t you look at the schedule?” Natalie, pulled me aside and said, “wait, we got an emergency.”

Emergency Radiograph

Bicuspid Tooth. Upper Right. A two rooted tooth split down the middle
Clinically fractured tooth. Almost split in 1/2. Ouch!

First of all, the patient had no idea how it happened. Furthermore, it just hurt real bad. Sharp pain upper right side. An incessant throbbing pulse originating from a single tooth. It seemed like the radiograph revealed no decay, although there was a very small amalgam filling. Clinically, it was grotesquely obvious. I did not need my high powered eyeglasses. There was a rude fracture running front to back through the tooth. Subsequently, Dr Swanson and myself concluded that the tooth had to go.

Restorative Options

Unfortunately, an extraction was only treatment “option”. Likewise, restorative options were limited. The No tooth option was discussed. In contrast, the patient was reluctant to be toothless. The dread of a removable partial appliance was not desired either. For that reason, the only non removable options were either a bridge or an implant. Certainly the cemented “fixed” bridge option was discussed, but we’d have to section off and further extend a perfectly healthy, functional, existing bridge anterior to this hopeless tooth. It seemed obvious. Almost instantly we agreed. He said,”Let’s do what we did several years ago; another implant.”

Treatment

The Immediate Implant was opted

Surgical Removal of fractured Tooth

Above all, local anesthetic consisting of 2% Lidocaine was delivered by Dr. Swanson. Subsequently, I surgically removed the tooth in total in an uneventful manner.

This tooth was split all the way down to the trunk aspect. Very difficult to do.

The immediate Implant Placed

Hence, a (4.1 x 12mm) Straumann BLT Dental Implant was immediately placed by me in replacement/substitute of his hopeless tooth.

Bone Graft and Collagen Barrier Placed

In addition, I carefully grafted cadaver donated bone material to fill the remaining “empty space” ie, socket void. Finally, I like to layer a bio-resorbable collagen barrier over the graft to direct the maturation of the new gingival growth. This is called a Guided Bone Regeneration Technique (GBR). I really enjoyed demonstrating the nuance of this technique to Dr. Swanson. Dr Swanson is currently enrolled in a prestigious Implant training Program in Florida. In addition to working full time here at the practice, she’s a full time mom. Way To Go Collisha!

Implant Placed in lieu of removed fracture tooth
Grafted and Barrier in Place prior to closure
Implant Placed in it’s proper position in solid bone.

Conclusion and Analysis

Hence, 7:30 PM presented a perfect opportunity for an immediate implant. The tooth area was free from underlying infection due to the timing of the acute injury. This patient was a non smoker; therefore extremely healthy with no underlying metabolic disease. His bone quality and quantity was ideal.

The most obvious advantage of the immediate implant is my ability to preserve bone integrity and “fake the body out”. The seamless switching a natural root for a man made one(implant) is a nifty trick. We know that loss of a tooth cascades into an immediate and rapid dissolution of surrounding bone structure. Therefore, it’s imperative to replace a tooth immediately, when one can, to minimize future degenerative changes.

Actually, his timing couldn’t have been better, for an expected excellent outcome. It would seem that immediate access to me was critical. Certainly, it was the end of a long day. The thought making a positive impact in my patients’ life is what energized my enthusiasm to do the right thing. Emergencies, as such, are untimely. Rather, this is the nature of my job. It appears that I am always on call. Who would of thought? I am a dentist not a medical doctor? LOL. I love what I do and it seems that it really is not work when you are doing what you love to do any time of the day/night.

It would have been easy for me to dismiss the patient with a prescription and a reappointment. Time with the onset of the inevitable acute infection would have transpired within a short time if the tooth was not immediately extracted limiting our restorative options further. Most note worthy, we did what we had to do to get the job done. Consequently we ultimately provided a tremendous service to another great patient.

As a result, in 3 months, the implant will be restored by Dr.Swanson to function with a perfectly functional crown.

Credits

Dr. Emilio & Associates,  Always Accepts  New Patients. He especially exceeds at treating same day emergencies patients suffering from tooth ache pains.

His goal is to keep his patients’ Teeth and Gums Healthy For Life.

Feel Free to appoint a Consultation with the Doctor. Open Six Days A Week

OPEN on Weekdays.  7:30am -8:00pm  (M<T<W<T)

Fridays.  7:30am-2:00pm

Weekends (Saturday only).  8:00am-2:00pm

111 East Avenue, Norwalk, Connecticut 06851.

You can always contact me directly via email  blog@robertemiliodds.com

You Tube : Robert Emilio DDS & Associates 

Instagram:  dentist_in_connecticut

Office (203)866-7164      www.robertemiliodds.com

Pass this Link to Your