Single tooth sites

Single tooth sites
August 2003
By Anthony G. Sclar, DMD
Journal of Oral and Maxillofacial Surgery, Supplement 1 Зѓў Volume 61 Зѓў Number 8 Зѓў p3b to p4
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Abstract
One of the most common applications of contemporary implant therapy is the replacement of an individual tooth with a compromised endodontic, restorative, or periodontal prognosis. Single tooth implant replacements also play a critical role in the rehabilitation of the partially edentulous that first seek treatment or subsequent to failure of previous fixed or removable partial dentures. Patients faced with the decision to salvage a compromised tooth, remake a fixed partial denture, or proceed with an implant replacement must be informed about the advantages, disadvantages, expected prognosis, treatment time and number of appointments required, options for interim provisional prosthesis, and economic impact of the respective treatment alternatives. With a clear understanding of these considerations and the risks and benefit associated with interventions such as endodontic therapy, surgical crown extension, and restorative procedures aimed at salvaging a tooth versus the removal of the compromised tooth with immediate or delayed implant replacement, and the impact of any necessary hard and soft tissue site development procedures, patients are able to make an informed selection of the treatment option that best fulfills their needs and desires.
Prior to patient education, the implant team must perform a comprehensive dental, periodontal, and surgical evaluation aimed at determining the plausibility and expected outcome of each treatment option. In addition to a general health survey, an important part of this evaluation involves the identification of factors that may limit the outcome of the proposed treatment options including: the root length, root morphology, and periodontal condition of the tooth in question and the adjacent teeth, the proximity of anatomic structures (maxillary sinus, nasal cavity, sensory nerves), the height and width of interdental bone on adjacent teeth, the height and width of bone at the edentulous site, the presence of adequate attached tissues and vestibular depth in the area, the inter-dental and inter-occlusal space, and the ability to achieve an optimal occlusal scheme in the final restoration.
Correspondingly, the replacement of a single tooth with an implant restoration may be as simple as the removal of a tooth with immediate replacement incorporating site preservation protocols to enhance functional and esthetic outcomes, or placement of an appropriately sized implant at an ideal edentulous site with subsequent restoration or may require a multidisciplinary approach involving orthodontic therapy, hard and soft tissue site development, prosthetic guided soft tissue healing, cosmetic periodontal surgery, and cosmetic dental enhancements of adjacent dentition in order to achieve the desired outcome.
An understanding of the compromise imposed by pre-existing anatomic limitations is necessary in order establish realistic expectations when vertical hard and soft tissues augmentation is necessary at single tooth sites. Furthermore, an understanding of periodontal and peri-implant hard and soft tissue anatomy and their response to the multiple surgical and prosthetic interventions is necessary in order to guide the implant team in the selection and sequencing of the surgical and prosthetic procedures necessary to achieve success.