Provisionalizing Edentulous Sites in Post- Orthodontic Case Part 2: An Eight-Year Dental Odyssey in a 22-Year-Old Patient’s Life

There are many options available to a dentist to provisionalize missing anterior teeth in a finished orthodontic case prior to definitive treatment that is usually performed when the patient has completed growth. We’ll explore some of these options in this article. The case presented is from a patient with congenitally missing maxillary lateral incisors that shows how I provisionalized those sites for five years prior to guided bone regeneration and root form implant placement at age 22.

Treatment Plan

The post orthodontic case shown is of a patient missing his maxillary lateral incisors (Fig. 1). The patient and his parents decided when age appropriate to restore these sites with root form implants, custom abutments, and porcelain crowns. I informed the patient and his parents that root form implants should not be placed until growth is completed.7 In a male patient, this would be after age 21 to be on the safe side (five years after the orthodontic treatment was completed in this case).

The next concern to discuss was how to provisionalize the missing maxillary lateral incisor sites for that length of time. After reviewing all of the provisional options discussed earlier, the patient and his parents desired a fixed option. The patient wanted to complete his high school and college years with fixed restorations. We decided to place 3M Unitek 10mm TADs (Fig. 2)2,3 in the maxillary lateral incisor sites and to fabricate E4D5 CAD-CAM e.max12 porcelain crowns to be resin bonded onto the exposed ball and grooved neck portions of the TADs (Fig. 2).

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Randy Newby

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