External Resorption Maxillary Anterior Teeth and Replacement: Thoughts?

medical history? something else is going on

It is a bit hard to determine the space between the laterals. However my advice would be to place two implants and provide single unit crowns on each. The aesthetics and maintenance is better but most importantly I feel it allows better function (less functional stress on implants and prosthesis). However if you do this, I would suggest you place one implant first – possible a delayed implant after the tooth in worst condition is extracted (allowing 4-8 weeks for the inflammation tissue to resolve). A graft will probably be needed. Then 6 months later extract and immediately implant the remaining site. The theory is that this lessens the loss of buccal bone - although I am not sure this applies in this particular case due to the existing inflammatory response and consequent loss of existing bone. I would guess the centrals had some sort of traumatic event when the patient was young and this has lead to root resorption.

I agree with Dr Gerke above in that I would probably not cantilever off a single implant in a central incisor site in order to replace another central. I realize that placing 2 implants side by side in the anterior can be an issue with regard to the ability to maintain the papilla, but I think the forces that a single implant would endure would be too great. The one thing I really don't like is the crowding present as well as the position of the adjacent roots on 7 and 10. This really may be a negative factor on implant placement/position. Thoughts on considering extraction/grafting of the centrals and then a removable temp followed by Ortho to straighten things out, upright roots and improve the bite? I realize this prolongs the case but sometimes stepping back and making the environment more favorable for long term success makes all the difference. Neil Zachs Periodontist

This is a case that could benefit from an Orthodontic consultation. Even a brief, several month intervention using a 3-D Quad Helix would open up the sutures between upper cuspids and laterals several millimeters, allowing much more available bone in the incisor areas. The records/x-rays/photos are not complete enough to allow proper evaluation and planning.

Ditto Dr. Manuel.

There is a severe crowding problem, and the teeth are in trauma occlusion. It would be best to bring an orthodontist into the picture, align the teeth properly, reduce the traumatic occlusion first....and if the centrals have to be extracted while this process is going on, they cane be replaced with a temporary removable prosthesis....once the trauma is taken care of, and the bone a chance to heal, implants to replace #8 & #9 can be considered....but first orthodontics ….for the upper and lower jaws.

I have seen a few cases like this. I am wondering if the patient has a hx of previous ortho therapy? I do agree that an ortho consult is strongly indicated

I agree with my colleagues Orthodontics to have sufficient mediolateral implant spacing ....And good occlusion.... It seems that the nasopalatine canal may need to be evacuated and grafted. Hart tissue augmentation facially [BMP with titanium mesh vertical and horizontal and deficiency]to allow for 3-D implant positioning .What is the bio type ? Autologous dentin grindings may also be very useful as a supplementary grafting material . Anterior open bite...Tongue thrust,reverse tongue swalowing......?. Temporization , Tissue conditioning....Oclusion..... on and on the tratment for this young woman requires an exceptinal clinician or avery talented team....I agree with my colleaguesDrs Gerke, Zacks,Manuel,and Rudick.... No cantilever.... Very complex tratment...... Take care

I agree with everything mentioned above. However, the treatment cost needs to be considered too. I would explore aligner treatment to correct anterior six teeth in both arches, & possibly consider veneering #7 & #10, plus two implants along with bone grafts. Good luck & let us know how the case turned out.