MBR JULY ALL

Malta Business Review
DENTAL HEALTHCARE
Malta Business Review
ADDRESSING COMPLEX
CASE SCENARIOS!
By Dr Jean Paul Demajo
In today’s dentistry aesthetics are as
important as functionality. Many patients visit
the dentist and tell them how happy they are
that their bridge or implant they had done
many years ago is still doing fine. What they
are unhappy about are the poor aesthetics
they carry. Most of this old dental work is
heavily constructed using old techniques
with possible visible metal. The frontal view
often shows receeded darkened gums by the
thin metal-ceramic edge of the border of the
crown. Spaces appear in between the teeth
and/or implants, again due to gum recession
causing dark shadows and food packing.
Food packing leads to plaque build-up and
inflammation. Yes this may be kept clean but
the aesthetics still leave much to be desired.
The fact remains that in most cases a bridge
or implant looks very good when inserted but
10, 15 or 20years later it looks very poor and
not in-keeping with the rest of the dentition.
OPTIONS FOR TREATMENT
1 Removal of the implant and adjacent tooth
with poor prognosis followed by two new
implants replacing the two missing teeth
and two new crowns
2 Modification of metal collar and provision
of new implant crown
3 Removal of implant and construction of
new all-ceramic bridge in zirconia or lithium
di-silicate replacing both teeth
4 Gingival plastic surgery to cover the metal
collar
This is a tricky case scenario on a patient
with high expectations. Each option
carries advantages and disadvantages.
Understanding that each option may bare a
good but possibly a compromised result, the
patient has opted for option 1. Here is the
sequence of events:
1 Explantation (removal of implant) and
extraction of adjacent central incisor
2 Simultaneous bone and gingival grafting
plus provision of removable prosthesis.
3 Placement of 2 new implants 3months
post-removal of implant and tooth with
further bone augmentation
4 Fitting of new all ceramic intermediate
implant-crown connections followed by
a metal free all-ceramic superstructure
4months post-implantation
Intra-op pre treatment
Intra-op showing two implants and two ceramic connections
The above shows that there are many
solutions to an aesthetic problem. What’s
important is knowing what options are out
there, explaining them to the patient and
selecting the best option to address the
patients wishes. Timeframes and costings
must also be weighed out.
Ask your dentist! MBR
A CASE SCENARIO
Middle aged man is unhappy
with an implant done
12 years ago
The implant has healed very well
Fully satisfied with performance
of implant but deeply unsatisfied
with current aesthetics
of tooth and gum
Extra-op pre treatment
Extra-op post treatment
DR JEAN PAUL DEMAJO
Dental and Implant Surgeon,
Trained in London working in
private practice in Malta
42 43
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