I’m currently treatment planning for a 50 yo female patient whose upper left anterior teeth (#9-10-11) are all horizontally fractured due to a bicycle accident.
My question is:
For optimal esthetic and long-term outcomes, would you recommend placing three individual implants (for three single-unit crowns)?
Or would you consider placing two implants at #9 and #11, supporting a 3-unit implant bridge with #10 as a pontic?
Would three single units offer better papilla support and allow for more predictable soft tissue shaping than a bridge?
Would love to hear your thoughts, especially from those with experience managing tissue contours and papilla in the esthetic zone.
Would you always go with 3 implants if bone and budget allow?
2 implants. I would not even consider 3. For the justification behind this I would suggest doing a lit search for papilla fill between adjacent implants, Implant-pontic, and Implant-tooth. Its a no brainer when it comes to anticipated esthetic outcome.
Another thing to consider would be to have a skilled hygienist provide a demonstration to the patient on how to utilize the fuzzy end of a toothbrush.
First thing I would do is introduce her to a toothbrush and see how things go for 3 months before diving into this case.
Secondly, I have found that when I have 2 adjacent implants, I consistently see the loss of the interdental papilla and end up with the dreaded black triangle
In the meantime, you can provide her with a temporary cosmetic denture like an Essex retainer. What’s the rest of the dentition like?
Good Luck, my friend!
This photo was taken a few days after the accident. The two fractured teeth were very loose and painful, so it’s completely understandable that the patient was hesitant to touch or clean the area. As clinicians, we need to put ourselves in the patient’s shoes to better understand what they’re going through, rather than criticising them.
You bring up a good point and I apologize for my sarcasm. Unfortunately since the accident was only a few days prior to the photo that might justify the plaque on the teeth but it takes weeks, if not months, of neglect to create the situation seen on her soft tissue. When I was doing my perio residency I was warned by our director to beware of the “bathroom brusher” and what this means is don’t evaluate oral hygiene base on the absence or presence of plaque on the teeth but rather the appearance/condition of the soft tissue. Either this patient has some sort of mucocutaneous/desquamitive gingivitis or they simply have not properly brushed for a really long time. On another note this level of inflammation will do wonders for helping to achieve papilla fill…
There is a lot of sub calculus so the patient needs a lot of help with oral hygiene and Perio health before launching into implants. Tissue heals better when it’s healthy.
