Dental implants offer some of the best treatment options for replacing missing teeth. With implants to support crowns and other dental prosthetics, patients get a result that is better for both aesthetics and function.

While more patients and dentists are starting to favour this solution, it is important to realize that every case is different and it is a multi-stage process that occurs over the course of a several months. Planning is not only the first step in the process, it is also one of the most important. Since it is so important to the success of these procedures, we would like to take a closer look at the planning stage of dental implant treatment.

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Patient Assessment

The first step is for the implant dentist to perform a patient assessment. The dentist will ask you about your concerns and the issues you are having. This is a time for the patient to describe their problems with missing or broken teeth, and why they believe they need dental implants.

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Along with asking about the patients problems, the dentist will also talk to the patient about his or her expectations. The dentist will ask the patient what result they are hoping to achieve by having dental implant treatment.

With an understanding of the patient’s concerns and expectations, the dentist will also need to review the patient’s medical and dental history. Some patients might have a health condition or other concerns that may be contraindications to dental implant surgery. It is important for the dentist to have a thorough understanding of a patient’s medical and dental history in order to assess their fitness for the surgery and whether there may be any issues that could increase the risk of implant failure.

Examination, Charting and Imaging

After the initial patient assessment, the dentist will need to perform a thorough examination of the patient’s teeth and periodontium. This includes examining the condition of the remaining teeth and looking for signs of gum disease and infection. All of these issues can be important when planning a patient’s dental implant treatment.

Beyond performing an examination to assess the patient’s current oral health, the implant dentist will also need to chart the mouth. This includes which teeth are remaining, which are missing, which teeth have fillings, if any teeth have had a root canal, and any issues that may exist with soft tissue in different areas of the mouth.

The dentist is also going to order images like X-rays and CT scans as a part of the planning process. This will help the dentist assess the bone at the location of the implant. A dental implant has to be placed in the jaw, so it is important that the bone has enough thickness, depth and density to support the implant.

The dentist will also need to examine the space where the teeth are missing to make sure there is enough room for the crown or bridge. In some cases, the tooth loss occurred many years ago. With the teeth missing in the space, it is possible for the neighbouring teeth to shift a little, and this needs to be considered when planning a dental implant treatment.

If you lose teeth and do not receive treatment for a long time, this can cause issues with both the amount of bone and with spacing. When you have your natural teeth, actions like chewing stimulate the jaw, and this helps to keep the bone healthy. When you lose a natural tooth and there is nothing to replace the root in the jaw, the stimulus is lost, and the bone can shrink with time.

Additionally, the adjacent teeth can begin to shift into the space. As this occurs, the space becomes narrower than it was when the person still had their natural teeth. If the space has gotten smaller, this can cause issues when planning for the replacement teeth that are to fill the space.

A Case to Illustrate Issues With Spacing

To wrap this post up, we would like to discuss the case of a patient who came to our clinic to replace teeth that were missing on the upper left side. The patient had been missing two premolar teeth for about eight years, and had not received any treatment to this point.

Two missing premolar teeth on upper left side

In this case, it was noted that the two premolar teeth had been missing for several years and the first molar tooth had in fact drifted towards the space. The patient was informed of this, and it was explained that it was not possible to fill the space with replacements that were exactly like the natural missing teeth that used to be in the space.

The space was large enough to fit two premolars, but they would have to be smaller than the original teeth that had been lost eight years prior. We explained that in order to provide replacement teeth that are an exact match to the original missing teeth, the patient would need to undergo orthodontic treatment to move the neighboring molar back to the position it was at the time when the patient lost the missing teeth.

It was decided in the end that we would make some trials with the study models for the patient to see what the replacement teeth would look like. If the new premolar teeth were going to be acceptable, the patient would proceed with two dental implants and two crowns, even though the replacement teeth would be smaller than the original.

artificial teeth on plaster model showing size of new teeth

The second option was to consider orthodontic treatment to push the molar tooth backwards in order to provide space for the two original sized premolar teeth. While this option would provide a better aesthetic result, it would also take longer since orthodontic treatment usually takes about 18-24 months to complete. Furthermore, the patient must also bear in mind the added cost of orthodontic treatment in addition to the dental implant treatment.

The third option would be to consider just one implant with one crown (and no orthodontic treatment). This one crown would be the same size as the original premolar teeth that had been lost.

By replacing just one tooth, a small space would be left behind the premolar tooth. It could be argued that the single tooth implant would be more aesthetic as the tooth would be more proportional in size to the original teeth. The disadvantage of this option would be that a small space would be left behind the first premolar.

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I hope this blog has not been too confusing. Hopefully, the pictures in the article helped to clarify. If you require any further information about dental implant treatment planning please feel free to Contact Brighton Implant Clinic or call us on 0800 111 6623.

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