Bone Shrinkage After Extraction
A 70-year-old man has lost several teeth in the top left for a while; one of front teeth is broken (Fig.1 (X-ray): #10). He is so afraid of dental surgery that he requests that 4 implants are to be placed at one time, including 3 for the missing teeth (Fig.1 white outlines). Since bone decreases the height after extraction (indicated by arrowheads), the implants in the back have to be short.
The bone width also decreases from the front to the back (Fig.2 between arrowheads), so do the implant size (black circles).
Where the broken root is taken out, an immediate implant is placed (Fig.3,4: #10), which is the largest among the four. The last 2 implants are a little too small and short (Fig.3-5: #12, 13) to have immediate crowns. In contrast, the front 2 implants are big and long enough to support 2 temporary crowns (Fig.5: #10 and 11). The last 2 implants are not a waste. They keep oral bandage in place (Fig.6,7 B, 1 weeks after treatment). The wound can heal quick with minimal pain. In fact, one week later, the bandage becomes loose and is gone. Although the last two tinny tiny implants are stable, two temporary crowns made over them must be joined together (Fig.8: #12, 13). The senior citizen is grateful, because he finally has something fixed in his mouth. He used to have removable partial denture made, but never wore it. It was not comfortable.
In one word, do not have a tooth taken out without placing an implant immediately. Bone shrinks easily after extraction.
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Xin Wei, DDS, PhD, MS 1st edition 09/19/2015, last revision 09/29/2015