Mike Skramstad I am pretty sure I have posted a lot of this before, but I wanted to post the entire case now that I am finished. Many of you in the courses have heard me tell of a good friend of mine that had a nasty trauma to his front teeth. It was a very difficult case to treat, but I think we got a reasonable final and he is very happy.
Here is how he showed up in my office the Monday after the accident. He took a blow to the face and vertically fractured both 8 and 9 all the way down.
I referred to my surgeon who was able to extract the teeth, place the implants, and do pretty extensive bone grafting. The one major compromise that we had was that the teeth were extremely difficult to remove. Because he had to incise the midline papilla with his flap design, I knew that we were going to lose the midline papilla on the final (I was right). I could have prevented this by placing custom healers right away (or immediate provisionals), but the surgeon did not feel comfortable with me doing this. I also could have been more patient with the treatment and let the ridge heal before implant placement or done more extensive soft tissue grafting. However, he was a good friend and I wanted to get him fixed up.... perhaps a regret that I would have not done with other people....
Because he had crowns on 7 and 10, I was able to remove the crowns and create/mill a 4 unit provisional for the healing phase. This really saved me because he would have had to wear a flipper or essix. With his job, that would have been a disaster for him. He is in front of people all day.
He wore the provisional for several months and here he was 4 months later. Notice the swelling above #8... we were freaked out thinking we were loosing the implant. Thankfully it turned out to be a loose healing abutment.
We then started the restorative process with Provisionals to attempt to form the tissue a little bit (although I knew the midline was not coming back at this point). I just sectioned the pontics out and left 7 and 10 provisionalized.
After another month and a half wearing these, we moved on to the final restorations (split technique with infiltrated zirconia abutments and e.max MT crowns on all 4 teeth)
While not a perfect result, I think it worked out pretty good for him. Sometimes, a long midline is required with implants on both of the central incisors. He was happy and he doesn't show everything when he smiles anyway!
