Managing Broken Teeth

Managing Broken Teeth

If you find yourself with broken teeth, it can be a true dental emergency. Whether it's due to trauma or biting down on something hard, such as a small stone or bone fragment, the fracture may vary in severity.

In some cases, the tooth can be smoothened or restored with an adhesive restoration. But for more catastrophic fractures, tooth extraction may be necessary. This can be done at an emergency appointment or scheduled for a later date if needed. In situations where extraction is delayed, removing the tooth nerve may be required to alleviate pain and discomfort.

When dealing with a missing tooth, there are four treatment options to consider. While no treatment may suffice for back teeth, most patients prefer replacing a front tooth. Options include a removable partial denture, a dental bridge, or a dental implant. Of these options, the dental implant stands out as the optimal solution. It doesn't involve adjacent teeth and provides superior aesthetics and functionality.

Throughout the dental implant treatment process, the challenge lies in ensuring a suitable tooth replacement.

Fixed provisional restoration are the preferred solution as they afford greater comfort and are less disruptive. If the neighboring teeth are intact or have small fillings, they can be utilized to seamlessly support the interim restoration. If the clinical crown of the fractured tooth is intact, it can be adhered directly to the adjacent teeth. In more complex cases where the affected tooth is broken into multiple fragments, an impression will be taken to create a provisional restoration out of composite dental resin. It effectively fills the gap left by the broken tooth and restores both form and function.

For patients with higher aesthetic demands, the adhesive Maryland Bridge is recommended. Crafted with a metal framework overlaid with porcelain, this restoration allows for greater customization to achieve a natural blend in both shape and shade with the existing dentition.

In some cases, adjacent teeth with crowns can provide support for a provisional bridge with a cantilevered pontic or replacement tooth. Additionally, patients with existing implants next to the broken tooth can benefit from a provisional restoration connected to the implant with a cantilever pontic. However, if fixed provisional restoration is not feasible or cost-effective, a removable partial denture can be used.

After the broken tooth is extracted, a 3-month healing period allows for the assessment of available bone volume and the need for bone grafting. A minor surgery follows to insert the dental implant into the jaw bone. After another 2-4 months of bone healing, a definitive restoration is fabricated through an impression.

While the process of replacing broken teeth may seem complex, with multiple steps and stages, it typically takes around 6-8 months. If you require further information on broken teeth replacement options, feel free to Contact Us.

Implant Fracture – Flange Fracture – Case Study

Implant Fracture – Flange Fracture – Case Study

Michael* presented at our clinic complaining that the dental implant crown on the lower right side of his mouth  was rotating. The implant had been placed and restored 4 years previously. Clincial examination revealed the presence of a screw retained crown on #46 that had rotated anti-clockwise, resulting in a gap between #46 and 45. We did not initially suspect an dental implant fracture.

Radiographic examination revealed the presence of a gap between the impant crown and the fixture platform. There was angular bone loss on either side of the implant, but was more pronounced on the mesial aspect of the fixture.

There also appeared to be a delamination of part of the implant below the mesial part of the fixture platform. We had not expected that the rotation of the crown was due to an implant fracture.

The screw-retained implant crown was removed and the fixture platform was exposed. There was complete fracture of about 40% of the lip of the fixture platform flange on the mesial part of the implant.

There was also a partial implant fracture of about 20% on the lingual aspect of the implant fixture. A flap was raised and the fractured portion of the flange was removed and the fixture was smoothened.

The flap was closed with a resorable suture and the screw-retained crown was then reconnected and the occlusion was adjusted to ensure there was no uneven occlusal contacts.

The abutment screw was tightened to the torque prescribed by the manufacturer and the access cavity was filled.

The patient was aware the implant fracture severely afftected the prognosis of the dental implant, and the dental implant would need to be removed if another implant fracture occurred.

*Not his real name.

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Catastrophic Implant Fracture – Implant Fixture – Case Study

Catastrophic Implant Fracture – Implant Fixture – Case Study

Occassionally, we encounter cases of implant fracture in clinical practice. Sometimes, modifications can be made to the fixture without having to remove them. At other times, the implant fracture is catastrophic and the fixture will need to be removed and replaced.

Steve* presented at our clinic complaining that his implant crown on the lower left side of his mouth was moving. The cliincal exam showed that the #36 implant crown was slightly mobile.

Radioographic analysis showed that ther was about 40% bone loss from the coronal portion of the implant fixture. The apical portion of the fixture appears to be well integrated, and no obvious fracture was noted of the implant fracture.

The initial diagnosis was that the cemented implant crown had decemented, and the patient was advised to have the crown removed, cleaned and recemented.

The area was anesthetized and an attempt was made to remove the implant crown on #36.

The coronal portion of the implant fixture was removed during the crown removal attempt. It was then that we realised that there had been a catastrophic implant fracture of the implant fixture at the level of the base of the abutment screw.

Analysis of the implant crown revealed that the cemented crown had a large buccal cantilever, which may have resulted in in excessive bending forces being exerted on the implant fixture, resulting in the implant fracture.

The bone loss around the implant could have happened before or after the catastrophic fracture of the implant fixture, due to the bending moments on the implant fixture.

The lower portion of the implant fixture surgically removed. After the site had healed, a new implant fixture was inserted to replace tooth #36.

*Not his real name

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My Dental Implant Hurts!

My Dental Implant Hurts!

If you're dealing with dental implant pain, it's crucial to determine the cause. Dental radiographs and a clinical exam are essential for a proper diagnosis.

An uneven bite can sometimes be the culprit, creating higher pressure on the implant crown compared to adjacent teeth. Adjusting the bite on the implant crown can often resolve these symptoms.

Loosening of the implant crown can also lead to discomfort, caused by factors like a loose retaining screw or dissolving cement. The movement of the implant crown can irritate the surrounding gum, resulting in pain. Luckily, this issue can be easily addressed by tightening the retaining screw or cleaning and re-cementing the crown.

Another potential cause of pain is gum infection. The movement of the implant crowns can cause inflammation and discomfort in the gums. Additionally, poor oral hygiene can lead to the buildup of tartar and plaque around the implant, which can further contribute to inflammation and pain.

Lastly, leftover cement in the gums from the crown delivery can act as a breeding ground for infection, resulting in discomfort. Proper cleaning of the affected area, typically performed under local anesthesia, along with antibacterial rinsing and prescribed antibiotics, can help resolve gum infections.

Bone infection around the dental implant is also a possible source of pain. It can occur at different depths within the jawbone, impacting the prognosis of the implant. In less complex cases, a minor surgical procedure is performed, involving lifting the gums, cleaning the implant surface and surrounding bone, and conditioning them with medicaments. Additional bone grafting may be required. The gums are then repositioned and stitched back into place.

Severe infection and significant bone loss around the implant may result in inadequate bone support, leading to implant mobility and integration failure. In such cases, the implant may need to be removed. After the necessary healing period, a new implant can be placed in the same location.

If you're experiencing any of these issues, please don't hesitate to Contact Us for professional assistance.

My Dental Implant is Moving!

My Dental Implant is Moving!

Is your dental implant loose? Occasionally, some patients feel that their dental implants start to become mobile. This movement may be due to several different causes .

It could simply be a manifestation of the retaining screw between the implant crown and the fixture becoming loose. This is pretty easy to fix. Your dentist just has to retighten the retaining screw to the right level and seal the screw access hole. Sometimes, the retaining screw may need to be changed before it can be tightened.

If your implant crown was cemented onto an abutment, it could be that the cement seal was broken and the crown has come off. You would then need to see your dentist to have the implant crown cleaned out and recemented onto the implant abutment.

The worst case scenario is that the implant has become deintegrated from the jaw bone. This could be due to infection around the fixture, or excessive bite forces. In this instance, the implant would need to be removed and the bone allowed to heal. After a sufficient period of healing, you can consider placing a new implant into the jaw bone.

Should you feel that your implant is loose, do not hesitate to contact us. We will diagnose the cause of your problem and propose the appropriate solution.

Dental Implant Problems

Dental Implant Problems

So you had your new dental implants placed and they were fantastic! You could eat and smile with confidence. But recently, something just doesn't feel right. Are you experiencing having Dental Implant Issues?

It may feel a funny when you bite, or something feels loose. You may even notice a slight swelling in the area of your implant or have some pain. What is going on? What has happened? More importantly, what should you do next?

Problems with dental implants can occur at the level of the implant fixture, the gums or bone around the implant or the implant crown. There are multiple possibilities that could be resultin the pain or discomfort you are experiencing.

You will need to have a consultation with a Dental Specialist experienced in dealing with dental implants. The specific problem you have will have to be identified and diagnosed with a clinical examination and dental radiographs, and once this is done, a solution that addresses your problem will be proposed to you.