Case histories

Can you tell which of theses upper front teeth is replaced with an implant ? Scroll to the end of this section for the answer.

Single tooth replacement
	This patient had a missing upper premolar and the resulting gap was very visible. A conventional bridge would have involved further damage to the adjacent teeth. A single implant was inserted and the abutment seen on this picture was inserted into the implant after twelve weeks.
	The final crown or cap has been fitted and blends in with the colour and shape of the other teeth.
Replacement of several teeth
	This patient has five upper teeth missing and she had previously worn a large plastic denture. Three implants have been placed and the abutments fitted to the implants twelve weeks later.
	A porcelain and precious metal bridge has been made to fit over the abutments.
	The bridge has been permanently fitted onto the implants. It looks and feels like natural teeth.
All upper teeth replaced
	This patient has previously lost all upper teeth and has been wearing a large plastic denture which was loose and uncomfortable. Four implants have been placed into the bone of the upper jaw and small spherical attachments screwed into the implants.
	The new replacement for the missing teeth is much smaller and thinner than the previous denture. Most importantly, it is completely firm and comfortable when it is in place. The teeth are removed by the patient to maintain good oral hygiene.
All lower teeth replaced
	Following the loss of all her lower teeth, this patient was unable to eat in comfort. Two implants have been placed into the bone of the lower jaw and a gold bar fitted to the implants. This forms a very secure fixing for a complete denture which clips firmly onto the bar. The denture is removed for cleaning. the patient can once again enjoy eating a varied diet without discomfort or embarrassment.
Complete tooth replacement with a fixed bridge
	This patient has all lower teeth missing. His previous dentures imposed severe restrictions on his diet and were loose and uncomfortable. He has now had six implants placed into his lower jaw and a fixed bridge has been screwed onto the implants.
	The bridge replaces the missing teeth and is not removable. The patient reports that it is like having his own teeth back again and is very natural in feel and appearance.
Answer from top of this section
This patient lost his upper right central incisor tooth in an accident. an implant was placed in the upper jawbone under local anaesthetic soon after the accident. There was no need for any further surgery and the crown was fitted on the implant six weeks later. It matches the natural teeth perfectly in shape size and colour. The gum around the tooth which shows when the patient smiles, follows the natural contours of the gums around the other teeth.

A Patient Profile

Name: Richard Dunwoody MBE

Occupation: National Hunt Jockey

Three times runner-up in the Jockey's Championship, four times the Jockey's Association "National Hunt Jockey of the Year" and Champion Jockey three years running (1992, 93, 94), Richard is one of our outstanding jockeys. With over 1,300 riding successes he is second only to Peter Scudamore in total career winners. Amongst his many major wins are two Grand Nationals (Miinnehoma 1994 and West Tip 1986), the Welsh National, the Irish Grand National (Desert Orchid 1990), the Whitbread, the King George VI Gold Cup three times, the Cheltenham Gold Cup and the Champion Mile.

Home Town: Born in Belfast now living in Oxfordshire.

Sports & Interests: Golf, Cricket, Water Skiing and Motor Sports.

The Background to the treatment: Born in Belfast into a racing background - his father was an amateur jockey and trainer and his grandfather trained at Epsom - Richard moved with his family to Gloucestershire when he was eight.

One day in the school playground there was a simple, accidental clash of heads and Richard lost one of his front upper teeth. His dentist put in a post and crown but, as his jaw was still growing, it kept falling out leaving Richard embarrassed and the gap - toothed target of jokes from the other boys. There was also the problem of waiting for dental appointments to have the post re-inserted, so when he was seventeen he had a dental plate fitted to replace the post and crown, but this was not without its problems. With a busy work schedule he found it difficult, if the plate broke, as it sometimes did, to get a quick appointment at once, and once when schooling a racehorse to jump, fell off in front of the owners and lost the plate - and only found it several weeks later.

After his experiences with a post and crown and dental plate Richard decided, in 1995, to have a permanent implant and crown fitted.

The Treatment Procedure: The consultation with the implantologist, Dr Adrian Watkinson in Bristol, confirmed that the implant procedure would be simple and straight-forward. As the tissue and bone surrounding the missing tooth had healed many years ago then it would be possible to start treatment without delay, using an ITI® Dental Implant to replace the root of the missing tooth.

This was inserted in a simple short operation performed under local anaesthetic in September 1995. Following the insertion it was necessary to allow sufficient time for the implant to integrate with the bone in the jaw to form a permanent replacement root and for the surrounding tissue to heal. During this healing phase Richard continued to wear a temporary denture and had to follow a very strict oral hygiene regime to ensure a speedy and successful healing of tissue.

After this healing period the restorative procedure began. An accurate model of the implant and surrounding teeth were taken and detailed records of the colour, shape and character to ensure an ideal match for the crown reconstruction.

Once the healing was complete the crown was fitted in December 1995 on its new replacement root, the ITI Dental Implant. The result is an aesthetically pleasing match to Richard's other teeth and, providing he continues with his present high standard of oral hygiene, his new tooth will remain in place for many years to come.

As Richard said in early 1996: "It feels great. I'm absolutely delighted! . No more problems."

P.S.

Some time after the implant/tooth was fitted, Richard had two very bad falls whilst racing. The crown was damaged but the implant remained firm in the bone and the abutment remained firm in the implant. It was a simple procedure to unscrew the crown, repair the fractured porcelain and refit the crown on the same day.

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