Because of delicate issues with the dentist who started this case, and the prominence of the patient, we are unable to show any actual clinical photographs or any other identifying information than what is shown here. But here is a model of the case.
This is the pre-operative modelof the woman who appeared in Dr. Chal’s office. She had gone to a dentist she felt was an excellent implant dentist, but sensed that something was wrong, and so stopped in the middle of the treatment and consulted Dr. Chal.
An examination showed missing teeth on her lower right side, and two dental implants placed.
The implants are way too far to what we would call the buccal side of her jaw – too close to the cheek side.
Dr. Chal placed two abutment attachments into the implants to better determine the angle of their placement and whether or not they are usable.
There are several errors in their placement. First, they are too far to the buccal (the cheek side) for the teeth that will need to be placed on them. Not only is this an esthetic problem (the teeth would appear stuck out), but they would be in cross-bite with the upper jaw, and the stress of that abnormal bite would not be healthy for the implants or the patient’s jaw joint. Not only that, but they aren’t in solid bone. There is very little or no bone on the buccal side, meaning that there is a high risk that the implants wouldn’t last over time.
Second, they are placed too close together for long-term function. There needs to be a certain amount of bone left between the implants for them to get fully integrated into the jaw and be strong enough to support chewing forces.
After a period of healing, a prototype restoration was placed to determine the optimal position for the two replacement teeth.
We see the new model with the implants solidly in place. They are placed in correct position to give support to the restorations that will be placed on them. And the final result will not only be long-lasting and functional, but the positions of the teeth will be esthetically appropriate.