Case Study : Mind The Gap!
Dr Firdaus Hanapiah
BDS(Otago) MSc(Lon.) FDSRCS(Eng.)
Often enough we see lots of patient who come to our clinics wanting to replace a missing or an unsightly tooth in the anterior part of the mouth. Usually the tooth missing is the first or second upper incisors.
Traditionally the dentist can offer a bridge to fill this gap. That means preparing the adjacent teeth which would often be completely healthy teeth to support a bridge. Not only the bridge preparation would mean an unwarranted destruction of the adjacent teeth, but as in our case report below, it would mean unacceptable aesthetics.
Mary (Not her real name) came to see us 9 months ago for a consultation on a missing tooth. Upon examination we found that she was wearing an upper denture after a loss of an upper right central incisor. She had seen another dentist from elsewhere and had replaced the lost tooth with an extraordinarily big tooth to cover the gap. She complained that her plastic tooth looked odd as it was bigger than her other teeth. Upon further questioning we discovered that she always had a gap between her front incisor teeth, also known technically as a median diastema. She was clearly unhappy with the appearance and wanted a “fixed” solution. She wanted her original “gap” back in between her two central incisors. Clearly a conventional fix bridge will not allow for a gap between the two incisors, therefore an implant would be the only solution.
An implant was placed and several months later a second stage was done in which an abutment was placed as seen in the picture above. Note the big gaps between the teeth and implant. The case was then restored with porcelain fused to metal crown as seen below.
Note after the placement of the crown, the patient was very happy in the sense that her “gaps” were restored and secondly none of her teeth need to be sacrificed for a bridge.
The advent of dental implants has given patients the choice of not having to sacrifice untouched or perfect teeth just for the sake of filling a missing tooth. In addition to that, those who prefer to restore the “gaps” between the teeth can do so with implants, something which was previously impossible with conventional dental bridges.