Case Study: Difficult Implant Case Causing Damage to an Adjacent Tooth


I recently treated a patient who had implants placed for missing upper lateral incisors about 15 years ago. There was a problem with the amount of room in her mouth.  To complicate the issue, the technology at that time was such that the smaller diameter implants were not available. In addition, the surgeon was not very experienced in doing implants.


When drilling the space for one of the implants, the surgeon gouged the sides out of one of the adjacent teeth, a canine which had been endodontically (had a root canal) treated before the procedure was started. This fortunate circumstance allowed the patient to not experience any pain on that tooth. Where the tooth was gouged under the bone, an amalgam (silver) filling was placed. This is a typical way of treating a failing root canal when the end of the tooth remains infected (known as an apicoectomy).

All was well until a recent x-ray revealed that the tooth has a horizontal fracture below the gum line. Previous x-rays looked normal except for the missing part of the tooth. In any case, the patient wants to be proactive and does not want to wait for the tooth to fall apart, nor does she want to experience any soreness or abscesses that may arise as a result of this untreated condition.

Before the tooth is to be taken out, a removable 1 tooth treatment partial will be fabricated. She will wear this through the healing phase plus during the time she will have the implant placed.   Once the implant has osseointegrated into the bone and is firm, the final impression can be taken for the permanent crown. It will take several months to get to this state.

In dentistry, small accidents can happen and at least there is a quality fix available most of the time.