Conservative Treatment First

A 43-year-old lady has 3 old crowns at #6-8 and 3 new crowns at #9-11.  The gingiva around the old crowns are erythematous and edematous.  CT taken 2 years ago shows subgingival calculus (Fig.3). 

Treatment plan is as follows.  Remove the old crowns.  After local anesthesia, finish regional scaling & root planing.  Fabricate provisional crowns.  Watch for 2 weeks with oral hygiene instruction.  If gingival inflammation subsides, take impression for final restoration.

If not, consider osseous surgery with bone graft or extraction and implant (Fig.4,5).  Cosmetics of neighboring implants is less ideal.

In fact osseous surgery is performed without provisional fabrication (Fig.6).  There is postop gingival recession between # 7 and 8 (Fig.8).  She agrees with extraction (Clindamycin) and implant (Fig.7: 3.8x12 or 14 mm).  To close the black triangle (Fig.8 *), fabricate one or two wide provisionals (Fig.9).  It may be necessary to harvest gingival graft from the palate.

Return to Upper Incisor Immediate Implant, IBS

Xin Wei, DDS, PhD, MS 1st edition 02/27/2016, last revision 01/19/2018