Treating congenitally missing teeth with an interdisciplinary approach
A 23-year-old female patient reported to the Department of Periodontology and Oral Implantology, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala to get a better tooth and gum esthetics. No specific past dental, family and medical history was elicited. No relevant findings were observed on extra-oral examination. Intra-oral examination revealed retained primary maxillary right and left canines. Diastema was present between maxillary central incisors and between right central incisor and primary maxillary canine. Distally tilted right maxillary second molar was present. Gingival and periodontal examination revealed healthy periodontium. Radiographic examination was done to evaluate the proposed site for implant placement, which included intra-oral periapical radiograph and orthopantomogram []. Based on the above findings, patient was diagnosed congenitally lateral missing lateral incisors and right mandibular second premolar.\nThe case was discussed with the Department of Orthodontics and treatment to be done was planned. Informed consent was obtained from the patient. Extraction of retained deciduous maxillary right and left canine was done. Simultaneous closure of midline diastema and bilateral distalization of maxillary canine was done to gain space between central incisor and canines bilaterally.\nWhen the sufficient interdental area between two teeth was gained [], the implant placement surgery was planned. Under local anesthesia, the crestal incision was given and mucoperiosteal flap was elevated. The site was initially with 2 mm pilot drill. The site was then gradually enlarged with standard color coded drills to the desired lengths at the osteotomy sites. The implant was delivered at the prepared osteotomy sites []. Primary closure of the flap was obtained with interrupted type resorbable sutures. Radiographic examination was done post-operatively []. Patient was prescribed non-steroidal anti-inflammatory drug ibuprofen 600 mg thrice a day for 5 days. Chlorhexidine gluconate 0.2% was prescribed for 2 weeks, soft diet instructions were given. After 5 months under sterile conditions, 2nd stage surgery was done using crestal exposure of implant cover screw. A healing abutment was placed with hex screw driver on each implant. At 2 weeks later impressions were made with open tray technique with impression copings placed into the implants. Shade selection was done. Healing abutments were replaced until prosthesis was manufactured. After a week, the healing abutments were removed and replaced by final abutments onto which final prosthesis was given []. Patient was happy with her new smile.