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This patient was referred by his Orthodontist after the braces were completed. As you can see the upper right front tooth is shorter than the other front teeth. In spite of trying to pull this tooth down to match the others it could not be accomplished. This phenomenon is called, "ankyloses" which means the tooth is "anchored" or "fused" to the bone. This can occur from a traumatic injury earlier in life. Ankylosis causes the soft tissue ligament to disappear. The soft tissue ligament is called the "periodontal ligament" or "Sharpey's Fibers". These ligaments hold the tooth in the bone by inserting into both the tooth and the bone. The tooth is really suspended in the bone by these ligaments. This is the reason that natural teeth move just a little. Once a tooth loses its ligament through this process it is stuck in that position forever. In this patient's case, it was too short for proper esthetics.
Close up view of upper teeth. Always trying to be as conservative as possible, the initial recommendation was to simply place a veneer on the tooth that was long enough to match the right central incisor. A temporary crown was placed on the tooth.
Just a few weeks later another pathologic process was noted: "root resorption". Again, childhood trauma can lead to this phenomenon. Root resorption is caused by the body's white blood cells incorrectly recognizing normal cells as abnormal cells and begins attacking them. This can progress slowly, over many years. However, when the tooth in question is challenged by a dental insult such as a orthodontics or a restoration it can accelerate the root resorption as happened in this case. Note the red hole where the tooth meets the gums, just left of the middle.
X-ray of tooth showing much more aggressive resorption below the gum line. After this discovery, we decided a dental implant was the only viable course of action.
Tooth extracted, implant placed.
After two months of healing, an abutment is placed on the implant preparing for a temporary crown.
Temporary crown in place. Temporary crowns should look very natural. Many offices seem incapable of making nice temporary crowns.
Final implant crown in place.
Side view of implant crown. Note the very close match of color, shape and thickness.
X-ray of final implant and crown.