Cleaning and Follow-up

Mr. Li (husband) has pretty severe gum disease.  He returns for cleaning every 3 months.  All of his teeth are solid.  In contrast, Mrs. Li (wife) has also severe gum disease.  X-ray taken 3 years ago shows that one of her front teeth (lateral incisor: L in Fig.1) has bone around the root (*).  She came to our office once and had deep cleaning done.  For 3 years, she has not returned for follow-up or cleaning. 

Suddenly she comes back because the lateral incisor develops a big swelling (S in Fig.2,4), and an abscess (*).  The tooth is very loose, moving down (Fig.2 arrow) and back (Fig.3 arrow).  New X-ray shows that there is no bone surrounding the front tooth (* in Fig.3) so that the tooth is so free that it shifts down by itself (arrow).

After deep cleaning, the loose tooth is extracted and an implant is placed immediately (Fig.5 I).  The top of the implant is supported by her own bone (*), while the lower portion of the implant is surrounded by bone powder(red circles).  The latter will turn into our natural bone in due time. 

At this moment, the implant is strong enough to hold a new crown instantly (Fig.6 C). 

The patient returns for root canal of the central incisor 3 weeks later (Fig.7 *).  The temporary crown is stable and the infection is gone (Fig.8 <).  Surprisingly, she returns for cleaning 3 months later (on schedule).  New bone appears to be forming around the implant (Fig.9 *).  Her teeth look bright after professional cleaning (Fig.10)!  We are going to make a permanent crown for the implant tooth soon.  In fact, she is so afraid of dentistry that she does not return for permanent crown (C) until 10 months after implant placement (Fig.11,12).  The infection in the neighboring tooth is reducing (Fig.11 *, as compared to Fig.1,3,5,7,9).

In brief, regular follow-up and cleaning is the best way to keep our bone and natural teeth.

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Xin Wei, DDS, PhD, MS 1st edition 05/24/2014, last revision 03/22/2015