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Replacing a Congenitally Missing Lateral Incisor / Marketing Your Dentistry After It’s Completed

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“Live sensibly in the present, carefully plan the future by flexibly adapting to changing circumstances, and accept the past. Reveal your integrity by laughing at yourself, admitting your mistakes, learning constantly,and cheerfullydoing the thingsahead that arewithin your power.”

—The 7 Habits ofHighly Effective People
Replacing a Congenitally Missing Lateral Incisor
By Dr. David Shorten; Louisville, KY

Replacing congenitally missing maxillary lateral incisors has always been a challenge for restorative dentists. This case demonstrates the advantages of utilizing a multi-disciplinary approach to this age-old problem. In the past I have tried Maryland bridges, that were conservative but failed on a regular basis due to de-bonding, Fixed bridges with full crown preps, reliable but with some aesthetic challenges and irreversible damage to the abutment teeth, and removable prosthesis.


In this case, we utilized orthodontics (Dr. Stew Jeffries), Oral Surgery (Dr. Rob Schroering), and Periodontics (Dr. Doug Lowy), to restore this highly aesthetic zone of a missing #10.

The patient was presented to my office as she was completing her orthodontic treatment. She and her parents were contemplating an implant for this area and were seeking my opinion. I was told the braces were to be coming off at the next appointment.

The treatment plan now was to improve the space discrepancy from the right and left side and move the root #11. She was referred to Dr. Rob Schroering for evaluation for the implant. It was determined that the alveolar ridge was too thin to get optimal placement of the implant. An autogenous block bone graft from the symphysis was placed and allowed to heal for four months. The bone graft provided plenty of width and tissue support for excellent results.

We also decided she would benefit from some minor crown lengthening. Dr. Doug Lowy utilized a combination of laser and traditional surgery for the crown lengthening. Figure 1 is after the bone graft but prior to crown lengthening and implant placement.

An interim flipper type partial was constructed for her to wear during this phase of treatment.

After the crown lengthening and healing of the bone graft Dr. Schroering placed a 3.7 x 13mm Zimmer implant in the #10 area. The patient was returned with a healing cap in place. She also whitened her teeth with custom take home trays and Discuss Dental Night White.

The case was sent to BECDEN Dental Lab for fabrication of an Authentic porcelain crown and an Atlantis Zirconium abutment.

Pictures were sent to the lab with shade tabs for shade selection and characterization match. The crown was returned finished and ready to seat, and now we have a very happy patient.
Abutment in place with a soft tissue model.

For more information visit www.smilepix.com. For BECDEN clients whose patient accepts the treatment plan consisting of six or more units, BECDEN credits your account for the cost of the imaging for that patient. If you are not sure this will work for you, give it a try since the first image with SmilePix is complimentary!
Published by BECDEN Dental Laboratory
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The editor of this newsletter is Emily Webb of Becden Dental Laboratory, Inc. Please send any questions or comments about this newsletter, or suggestions for articles to: emilyw@becdendental.com

©2007 BECDEN Dental Laboratory, Inc.