Missing tooth and Pain in the upper front region of the jaw Case Study

• Name- Mr. Vishal Sharma
• Age- 35 years
• Gender – Male

1. Missing tooth
2. Pain in the upper front region of the jaw

Dr. Rajat Sachdeva MDS, MS, Implantologist at Dr. Sachdeva’s Dental Aesthetic and Implant Center, Delhi.

Accidents or sports injuries are common causes of traumatic dental injuries. Most of the injuries are minor, such as chipped teeth. Dislodging the tooth or having it knocked out completely is less common, but these injuries are severe. Each injury’s treatment is determined by its type, location, and severity.

Regardless of the severity of the injury, the tooth should be examined by a dentist or an endodontist right away. Additional, unnoticed damage to the nearby teeth can sometimes occur, which can only be detected by a complete dental examination.

Mr. Vishal Sharma visited Dr. Sachdeva’s Dental Aesthetic and Implant Center and presented for a restorative consultation regarding his missing teeth in the aesthetic zone in the maxillary dentition. His chief concern was the discomfort during the functions and the reluctance to smile or speak due to missing teeth.

The patient, unfortunately, met with an accident due to which he lost his upper front teeth. In past years, he was treated for the same complaint by different dental professionals but faced failures with treatment procedures twice in that region.

Dr. Rajat Sachdeva, one of the best dentist in Ashok Vihar, Delhi, examined the patient. Detailed intraoral examination revealed that the patient has missing #11 and prosthesis with #21. Various diagnostic measures carried out in which Dental X-ray report suggested:

• missing #11 with severe bone loss in the same region
• RCT treated with#21
• resorption in third apical root with#21
• periapical lesion present with #21
• CBCT sectional anterior maxilla report suggested that:
• minimally displaced vertical fracture in the palatal cervical third of the roots with #21
• partially remineralized root socket with coarse granular osseous graft-like density in cervical third and adjoining labial alveolus extending till inter radicular region #12 and #13.
• numerous coarse condensed randomly oriented trabeculae with intact adjoining cortices seen in underlying alveolus #11 and #21 suggestive of D3 type bone.
• asymmetric apical root resorption noted with #21.
• Coarse granular graft-like radiodensity was noted in adjoining labial alveolus of #21 and along the superior aspect of the lesion.
• diffuse periapical-periradicular rarefaction noted with thinning intermittent effacement of adjoining labial cortical plate noted s/o granuloma or abscess with #21.
• Endodontic restoration was noted with #21.

After discussing all the pros and cons of the following treatment options, our dentist introduced the patient to different prosthetic and restorative treatment options. Extraction with #21 followed by immediate implant placement in #11 and #21 regions was the most appropriate treatment.

Our dentist administered 2% lignocaine and adrenaline (1:80000) in the #11 and #21 regions. Then, our dentist carried uneventful extraction of #21, created a midcrestal incision, and released a full-thickness flap. Bone width was measured according to the protocol for implant placement.

Ostectomy was drilled, and parallel-sided, threaded two implants were placed (Straumann roxolid implants 4.1*12mm size) followed by placement of the bone graft. Further, our dentist placed Mersilk sterilized sutures, approximating the soft tissues.

The patient was provided with a temporary esix retainer with the crown after surgery. Then, our dentist advised the patient to follow all the post-op instructions, take medications, and maintain good oral hygiene.

Suture removal was done after seven days. Further, our dentist performed second stage surgery after eight weeks where putty light body impressions were taken for jig trial and bite recorded for the prosthetic reconstruction in #11 and #21 region. Lastly, our dentist placed the final prosthesis of implant-supported E-max crowns.

• Tab. Augmentin 625 mg BD
• Tab. Metrogyl 400mg BD
• Tab. Zerodol SP 200mg TDS

• Soft diet and liquids intake
• No spitting for 24 hrs
• Ice pack massage
• Maintaining a good oral hygiene
• Regular brushing and flossing

This is what the patient, Mr. Vishal Sharma has to say about the treatment: ” I am very satisfied with the treatment. Previously, I suffered from severe toothache and hesitation while smiling due to the missing teeth. But now, I feel comfortable and confident, thanks to Dr. Rajat Sachdeva.