Youth Redefined
Problem: this patient has a genetic condition that results in the absence of development of some adult teeth. As such the baby teeth at these sites may remain through into adulthood, causing an obvious aesthetic issue (e.g. larger prominent front teeth), but also a functional one, since such smaller teeth can become loose and unstable over time. Additionally where the adult teeth do not develop, this leads to (sometimes large) deficits in jaw bone volume in these areas which makes future implant treatment more complicated.
Solution: in order to satisfy the end goal objective of having full adult sized fixed teeth, a substantial amount of bone was grafted to the site of the existing baby teeth which were extracted, and an interim temporary set of dentures were provided. A second operation to harvest the necessary bone from the patient’s hip was undertaken in hospital at the same time as grafting it into the mouth. Implants were placed at key sites following healing, and after a period of temporary teeth to allow gums to reshape, the final implant bridges were fitted. There were numerous parameters to control all the way through such a complex and multi-disciplined case but no small details were left unchecked. In fact at the end of a long journey we decided to adjust the upper right front tooth in order to lengthen it – a seemingly minor procedure in context of previous events, and although very subtle had a noticeable impact. We were equally thrilled with the very natural gumline that resulted from careful temporary teeth provision.
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Discussion Points: such cases are not uncommon and will be monitored and reviewed throughout childhood by a team of general dentists as well as paediatric and other hospital specialists. We would like to stress that bone taken from the hip is only needed in cases where the requirement is deemed very large (as assessed on a 3D x-ray or CBCT). Grafting is usually far less invasive and locally harvested from the mouth or indeed via synthetic materials. We were delighted that the outcome of all surgeries was uneventful and went according to plan, allowing for a truly life-changing result for a patient who was finally able to start a new chapter in her adult life.
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