Case report
The short haul T
he use of tita- nium implants in dentistry has provided the clinician with a
predictable way of replacing single and multiple teeth. From a patient’s point of view, most would prefer to have the tooth or teeth replaced at the time of extraction. This can be done in a shorter time and with reduced discomfort. They will also have their treatment completed in a fewer number of visits. This paper reports on the
replacement of premolar and a molar tooth in the upper right quadrant using immediately placed titanium implants.
Case report A 52-year-old lady (CM) was referred to Scottish Centre for Excellence in Dentistry by her general dental practitioner
Fig 1
(GDP). She’d had a bridge constructed in the upper right quadrant of her mouth many years ago, replacing ı5 with ı4 and ı6 as the abutments. The bridge had come out
on a number of occasions and at the time of referral, it was loose. The patient was not keen to have a partial denture, even on a temporary basis due to her work/life commitments. She had attended another prac- tice for assessment for implant treatment but was informed that it would not be possible to treat her without using a partial denture on a temporary basis. She was seen by myself in
Scottish Centre for Excellence in Dentistry. She was not in any discomfort when she was seen, but she did feel that the bridge was loose. She reiterated that at no time did she wish to have a partial denture. She works
as a consultant for an inter- national cosmetics company, meets many people during the course of her working day and also has to give presenta- tions on a regular basis. She felt that a denture would not be comfortable, especially in the early days following the surgery and that it would inter- fere with speech and eating. She also felt it would reduce her confidence. I could not disagree with any of this! Medical history revealed
that she had an allergy to Augmentin. She had been attending her GDP for routine dental care, brushes three times daily and uses dental floss. She previously had implant therapy to replace ı2. She is a non-smoker and drinks two units of alcohol per week. On examination there was
no tenderness around the temporomandibular joints
Immediate replacement of teeth using titanium implants – a case report by Arshad Ali BDS, FDSRCS (Eng & Edin), FDSRCPS (Glasg), DRD, MRD, RCS (Edin)
or muscles of mastication. Her oral hygiene was slightly deficient with BPE’s of 2-2-2 and 2-2-2. She had a heavily restored
dentition. As mentioned earlier, she’d previously had a bridge replacing ı5, with ı4 and ı6 as the abutments. There was recession around ı4 and ı6, with reduced keratinised tissue present on the buccal aspect of the abutment teeth. There was also grade one mobility of the bridge. She had a Class I occlusion with anterior and canine guidance. For detailed assessment,
a low dose i-CAT CT scan was taken which showed that there was a distal perforation of the post in ı4. There was also a small peri-radicular area related to ı4, there was adequate bone beyond the apex of ı4 in which to place an implant and there was also adequate bone in the ı5 position in which to place an implant. Additionally, there was a peri-radicular area related to ı6 with limited bone volume in this site. There were also peri-radic-
ular areas related to 27 and 46. These were pointed out to the referring GDP. The following diagnoses
were made: • missing teeth • chronic periodontitis • heavily restored teeth • peri-radicular infection • failing bridgework. The treatment options were
Pre-op CT scan 56 Scottish Dental magazine
discussed with CM. She had already intimated that she did not wish to have a partial denture even on a temporary basis. Bridgework was not possible due to the lack of a distal abutment and a distal
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