Dental Implants Supporting a Cosmetic Smile Makeover

Congenitally Missing Teeth: A Challenge Requiring Multidisciplinary Team Approach

This patient was referred to Elite Prosthetic Dentistry by her Orthodontist and General Dentist when she was fifteen years old. The reason for this referral was that she had congenitally missing permanent teeth, meaning she was born without certain teeth that should have developed normally. She wanted to undergo a smile makeover using dental implants to replace her missing teeth.

Congenitally missing teeth present a unique challenge in prosthodontic treatment because the patient has never had these teeth. The space in the dental arch where they should be may not be adequate, the bone may not be properly shaped, and the adjacent teeth may have shifted into the spaces where the missing teeth should be. Restoring the proper smile and function requires careful planning and coordination among multiple dental specialists.

Coordinating Care During Active Orthodontic Treatment

Even though this patient was in the middle of orthodontic therapy when she came to Elite Prosthetic Dentistry, we were called upon to provide guidance on optimal tooth positionings. Our role was to ensure that the orthodontist would move her teeth into positions that would provide adequate spacing for the future placement of dental implants to replace her missing teeth.

This type of coordination is critical. If the orthodontist moves the teeth without considering where implants will eventually be placed, the spacing and arch form may not be ideal for implant restoration. By working together with the orthodontist from the beginning, we were able to ensure that her orthodontic treatment would prepare her mouth for successful implant restoration.

Important Timing Consideration: Waiting Until Growth is Complete

A critical principle in implant dentistry is that implants should not be placed in children until they have stopped growing. This typically occurs at around eighteen years of age. Our young patient needed to complete her growth period before implant placement could occur. This waiting period gave her time to complete her orthodontic treatment and for her skeletal and dental growth to stabilize.

Building the Ideal Team for Complex Restoration

To provide this patient with the best possible results, we assembled a precision team of practitioners. The team included:

• An orthodontist to establish proper tooth positioning and arch form
• Oral surgeons for any surgical procedures needed
• A periodontist for bone grafting to establish adequate bone architecture in sites where implants would be placed
• An endodontist for necessary root canal therapy on teeth that required this treatment
• Dr. Marlin, providing prosthodontic oversight and final restoration design

This multidisciplinary approach ensures that every aspect of the treatment is optimized. Rather than having a single provider attempt all aspects of the case, our coordinated team approach allows each specialist to contribute their expertise.

Strategic Bone Grafting for Implant Success

Before implanting the restorations, the periodontist performed bone grafting at the sites where the missing teeth would be restored with implants. This bone grafting procedure ensured that adequate bone volume and architecture were present to support the implants long-term. Bone grafting is often essential for success when dealing with congenitally missing teeth, as the bone in these areas may not have developed normally.

Implant Placement and Osseointegration

Once all the preparatory work was complete, including completion of orthodontic treatment and bone grafting, we placed the dental implants in carefully planned positions. The implants were then allowed to fuse to the bone in a process called osseointegration, which typically takes several months.

The X-rays from the case show the implants in place, with the red arrows indicating the implants that had successfully fused to the bone.

Final Restorations: Custom Crowns for a Natural Smile

Once the implants had fused to the bone, we fabricated custom abutments for each implant. Abutments are the connectors that link the implant to the crown. We then created final custom-crafted crowns that were cemented over the abutments.

The final result is that this patient now has a complete dentition. All of her teeth are present and properly positioned. Her smile is beautiful, natural-looking, and fully functional. She can bite and chew properly, and she has confidence in her appearance.

Transformed Life Through Comprehensive Prosthodontic Care

This patient is so thrilled with her results that she is considering going to dental school. Her smile transformation has had a profound impact on her confidence and her sense of possibility for her future. This case demonstrates the power of comprehensive, coordinated prosthodontic care to transform not just a smile, but a person’s life.

Comprehensive Care for Complex Cases

If you have congenitally missing teeth, or if you need comprehensive smile restoration involving multiple specialists, contact Elite Prosthetic Dentistry at 202-244-2101. We have the expertise and the connections to coordinate care among multiple specialists and deliver exceptional results.