Orthotown September 2020 - 19
It appears the LLE and LR5 have contributed to the shape of the upper posterior segments.
She might benefit from rounding out the arches, filling the buccal corridors. The U4s, 5s and
6s probably wouldn't have tilted in and down, resulting in posterior excessive gingival display. ■
Terry Gruelle
Member Since: 05/03/08
Post: 6 of 16
7/11/2020
Yes. That's a good observation. But at this point she's stuck with this implant and the anterior
aesthetics are really bad. I can see why she hates her smile. I'd talk to your periodontist and
prosthodontist and see what you could do as a team. ■
socoortho
Member Since: 03/21/08
Post: 7 of 16
7/12/2020
Time and money solves quite a few problems. Maybe remove, consider a porcelain-bonded
bridge or temporary pontic with bone graft and eventual replacement after positioning the anterior
teeth for cosmetics and function. ■
danbraces
Member Since: 11/09/08
Post: 8 of 16
7/14/2020
This is the dreaded implant in a VME patient. I would agree that sending this to a good
periodontist and prosthodontist is the starting point.
It looks like the clinical crown of the implant is shorter and therefore there is a noticeable
difference in the gingival show of #7 compared to #10. This would likely require taking the implant
out. Grafting for more labial bone and placing a bone-level implant to improve the emergence
profile of the crown. It's a tough situation to solve. ■
justinudm
Member Since: 09/29/14
Post: 9 of 16
7/14/2020
Consideration of exo upper
2s/LR5, LLE? ■
tchae86
Member Since: 05/21/12
Post: 10 of 16
7/18/2020
Fenrisúlfr
T h a t 's a b old pl a n ! I
Member Since: 02/25/09
wou ld consider it a f ter
a
Post: 11 of 16
detailed IC and making sure she
understands that the 3s and 4s may need restorations. ■
7/19/2020
dhmjdds
Thanks for all of the comMember Since: 11/16/04
ments! Interesting thought,
Post: 12 of 16
extracting the lateral, removing the
implant and resolving the lower crowding with extractions
as well. This is definitely a plan I will present to her.
My periodontist has asked to have a consultation
with her to evaluate the implant and gingiva, so we'll be
getting that set up. But first I will be meeting with the
GP to get his thoughts on the situation. Then probably a
consult with prostho will be needed also. We don't have
a lot of prosthodontists in this area.
My daughter, who lives in Pittsburgh, looked at the
records as well. She did an implant fellowship and does
a lot of implant work. She knew immediately from the
appearance that a GP had placed the implant and crown.
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Orthotown September 2020
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