Treatment: Dental implants to replace congenitally missing teeth
Rose was self-referred to our center after multiple attempts at replacing her congenitally absent teeth had failed. Inadequate bone volume for implant placement necessitated extensive bone grafting but this was unsuccessful after two attempts.
Unlike most people that develop thirty two teeth, as many as 16% of the population have at least one tooth missing because of developmental failure. Hypodontia, or missing teeth, due to developmental anomalies are most commonly seen in association with congenitally absent third molars and upper lateral incisors, with varying prevalence reported in different populations ranging from 0.5. - 37%.
Rose had a unique situation where she had 9 permanent adult teeth that were congenitally missing. At presentation, she had 5 teeth missing in the upper jaw that were of priority for replacement. Prior to seeking an opinion from the Portland Perio Implant Center, she had unsuccessful bone grafting and implant treatment. Having listened to her main concerns, and after a thorough clinical assessment, a plan was formulated to provide Rose with both a functional and esthetically pleasing smile that she desired.
Cone beam 3D imaging and virtual implant planning softwares are used to plan implant placement based on a final restorative ideal. In turn, the presence of any bone deficiency base on the planned implant positions will be appropriately planned for as part of the treatment.
With the use of our 3shape Trios intra-oral scanner, a digital impression of the arches were made. A digital simulation of the final smile was produced and together with the 3D CT scan, a custom surgical guide was produced to aid the placement of the dental implants in the desired and planned location. Guided surgery facilitates the accurate 3D positioning of the implants in the jaw as they have been planned virtually.
Simultaneous implant placement and horizontal ridge augmentation was performed and a period of 4 months was allowed for healing. After uncovering the dental implants, three of the five implants that were in the esthetic zone received temporary crowns. The use of temporary restorations were aimed at sculpting the soft tissue profile. Once satisfactory tissue contours were achieved, permanent zirconia final restorations were fabricated and delivered.
Rose's story in her own words:
“As a person that’s congenitally missing 9 adult teeth it’s hard for me to find periodontists and dentists that aren’t dumbstruck by the enormity of my case. Luckily for me Dr. Haghighat isn’t one of them.
I was weary of private clinics because I’d been treated at the OHSU dental school since childhood and every private clinic I’d been to seemed to want to upsell my already expensive necessary dental work with veneers I didn’t need or want. I found Dr. Haghighat after researching bone grafting experts in the Portland area. I was devastated after I’d had two bone grafts I needed to complete the implant process, fail at the OHSU graduate student clinic.
I was very self-conscious about the large holes left in my smile from this process and very reticent to put myself through another year of surgery, check-ups and bills. I couldn’t eat certain foods and I was terrified of job interviews where smiling is expected. It was after being scheduled for a brunch interview (my absolute nightmare) that I made the appointment for a consult.
Meeting with Dr. Haghighat I was put at ease with how upfront he was about why he thought the grafting had failed and how he’d approach my case differently, going so far as to answer my nervous questions about worst case scenarios. I was also thrilled not to hear the word “veneer” once in his clinic.
The surgeries went well and he never hurt my jaw by leaning on it or jerking it as other surgeons had done in the past. The staff there is also really sweet, they always remembered the little details of my life. Today I had my final implant crowns placed. I’m so happy I can finally smile and chew again! I wish I’d seen Dr. Haghighat first. He’s honest and he wants to provide his patients with the smiles they deserve. I have one more baby tooth left to replace and when it’s time, I’ll be going back to his clinic. If you have a difficult case I cannot recommend him more.”
