Introduction:
In dental practice, aesthetic cases often challenge the standard protocols, necessitating innovative solutions and close collaboration. This case study details the comprehensive treatment journey of a patient in his 50s who suffered a traumatic dental injury resulting in the loss of a central incisor. The collaboration between Dr. Chong Lim and referring restorative dentist Dr. Antimos Ouzounogou exemplifies the steps required in handling such intricate dental situations.
Initial Presentation and Diagnostic Process:
The patient initially sought emergency care following the accident, leading to the loss of the incisal tooth. Besides appearance, replicating the area to pre-accident status was critical as the patient relies on this to produce music from a classical wind instrument. Fortunately, the patient had always maintained a set of study models in case of such an event! Recognising the complexity of the case, Dr. Antimos promptly referred the patient to Dr. Chong Lim for a shared treatment approach following stabilising the patient. A CBCT scan, conducted approximately one-month post-accident, revealed critical details: a retained root tip, apical fenestration, and a moderate-sized incisal foramen. This comprehensive diagnostic tool was pivotal in formulating a precise treatment plan.
Treatment Plan and Execution:
The primary challenge was to reproduce the osseous-dental-mucosa relationship. The apical fenestration required simultaneous Guided Bone Regeneration (GBR) to support a screw-retained implant restoration and connective tissue graft for overall harmony and longevity. The treatment plan involved the following steps:
- Root Removal + GBR + Surgical Procedure and Implant Placement Preparation: Piezo surgery was used to remove the retained root tip in an atraumatic approach, which was meticulously removed to prepare for the implant. Simultaneous GBR was achieved using autogenous bone chips sourced from the nasal spine, supplemented with deproteinised bovine bone mineral (DBBM) and a resorbable collagen membrane, providing a stable osseous foundation.
- Utilising a surgical stent, the Straumann BLT implant was positioned in the precise 3D location, as predetermined during the planning phase. This ensured the implant’s alignment with the patient’s natural dentition, facilitating a harmonious emergence profile.
- Post-Operative Evaluation: Post-placement assessments verified the implant’s optimal positioning, with the buccal view confirming the anticipated perforation at the apex and the successful integration of GBR materials.
- Provisional crown. A number of visits was spent to gradually condition the augmented soft to develop to the desire form. At the same time, the patient was taught how to use a range of oral hygiene aids
Definitive restoration: After 5-months on the provisional crown, Dr Ouzounogou the restorative dentist refreshed the old composites of the neighbouring teeth and produced a most natural looking implant crown. The patient came to us for a review. He brought and blew his own trumpet, commenting that the music produced was very close to pre-accident. His OH was also excellent.
Challenges and Collaborative Efforts:
The complexity of this case was managed through the strategic collaboration between Dr. Lim and Dr. Ouzounogou. Their combined expertise and use of advanced imaging surgical and restorative techniques were pivotal in addressing the anatomical challenges presented by the unique case.
Outcome and Lessons Learned:
This case underscores several key insights:
- Listen to patient’s needs. A ‘perfectly’ aligned dentition would not be suitable for this patient’s requirements
- Importance of CBCT Technology: The detailed anatomical insights provided by CBCT scans are invaluable in planning complex procedures.
- Advanced bone & soft tissue Grafting Techniques: The effective use of GBR & Connective Tissue Graft materials is crucial in establishing an optimal functional, aesthetic and healthy outcome.
- Collaborative Approach: The synergy between referring dentists and specialists is vital in managing complex dental cases, ensuring comprehensive and patient-centred care.
This case study highlights the necessity of meticulous planning, advanced techniques and professional collaboration in achieving successful outcomes in complex dental procedures. This case serves as a guide for practitioners facing similar challenges in their practice.
