Q: Dr. Crapo: Eight years ago at age 11, my front teeth met a golf club on the backstroke because I was standing too close. My teeth were shattered and my lips made hamburger in a millisecond. My dentist met me and my dad after hours on a weekend and attempted a patch job. He got the bleeding under control but I was so swollen and in pain that only the best first aid was possible. Over the next few days he removed fragments and grafted in bone so I’d have bone enough in the future for implants or a bridge to replace my two front teeth. I’m finished growing it seems, and I’d like to get permanent teeth to replace the flipper teeth I’ve been wearing for years. In the past two years, my teeth have been straightened so there’s room for two front teeth, but now I’m told I may have to have more bone added before the implants go in. Did the bone not stay put or did it go away? I thought I’d have enough. What are my options? The teeth on either side were not injured at all so they’re untouched.
A: You have several good options but let me address the question concerning bone volume. At age 11 the bone housing your teeth was not developed to its full height. When you had your accident the length of bone was not complete. Secondly, part of the boney ridge that housed your front teeth was probably destroyed in the trauma. Finally, the grafting procedure was likely a process of filling the damaged sockets with granular bone, not adding a solid piece of bone. Even if the graft was completely successful, it would have filled to the height of the child sized ridge.
Here are two options. The first would be a bridge. This would give you a nice result and your dental plan (if you have one) would participate to its fullest extent. The drawback is trimming down undamaged teeth on either side of the space.
The second option would be to place the implants and a grafting material at the same time. This is a more complex procedure, but works very well if done right. Review with the dentist, the cosmetics of this procedure. If you don’t show your upper gums when you smile, any cosmetic compromise would not be noticeable. Your dental plan will only help on the crowns; they will not involve themselves with the surgery or the grafting. While there are other permanent tooth solutions, they are more invasive and may not be appealing.
Have a thorough work-up and think carefully about what you want long term, both of these solutions should give you many decades of service.