- Email: [email protected]
Continuing facial growth changes crown position
Discussion.—The patient’s perception of an occlusal problem in phantom bite is rarely resolved successfully. Dentists who try to treat the problem with rational explanations often become embroiled in long discussions that have no positive effect on the patient’s delusion. General dentists may find obtaining a psychiatric opinion impractical and patients usually will not accept a referral readily, but psychiatric input can be valuable. Dentists and mental health professionals can work together to improve patients’ overall level of functioning by building adaptive coping behaviors. Among these is switching the patient’s goal from seeking a solution to the perceived malocclusion to learning to focus on other aspects of life. When treatment is successful, the ideation can become encapsulated and no longer constitutes the main focus of the patient’s life.
Clinical Significance.—Being aware that not all problems presented by our patients have a physical basis and being able to discern those that do not can save both the clinician and patient much effort in the wrong direction. Bear in mind, however, that because a problem is not physical does not mean it is not real.
Jagger RG, Korszun A: Phantom bite revisited. Br Dent J 197:241-244, 2004 Reprints available from RG Jagger, Dept of Adult Dental Health, Univ of Wales College of Medicine, Heath Park, Cardiff CF14 4XY; e-mail: [email protected]
Implants Continuing facial growth changes crown position Background.—Osseointegrated root-form endosseous implants are generally avoided in children and adolescents who are still growing because of the ankylotic behavior of the implants. Adult facial skeletal growth has been documented to occur into the third decade and can produce similar problems with these implants. An apparent change in the position of a crown luted to a single implant abutment for about 10 years was reported. Case Report.—Patient, 27 years 2 months, had a missing maxillary left central incisor for which a 3.25-mmdiameter implant was placed. The surgery was performed in 2 stages, with the second at age 27 years 9 months. A hex-lock abutment was prepared and placed about 1 month after the second stage, then a metal-ceramic crown was cemented 2 months after that, when the patient was age 28 years. The crown was purposely placed out of occlusion with the incisal edge about 0.5 mm
138 Dental Abstracts
shorter than the contralateral central incisor (Fig 3) based on the limited experience of the clinician with the loading capability of this form of implant-supported restoration. The patient was examined 4 years 9 months later and then 6 years 11 months after the cementation; no problems were detected at either evaluation. Ten years 7 months after the cementation of the crown, at age 38 years, the patient came for an esthetic improvement in the crown because it “seemed smaller.” The crown position demonstrated an apparent change on the left central incisor, with the incisal edge nearly 2 mm shorter than the right central incisor (Fig 5). No loss of cement seal was found, nor was mobility, damage to the incisal porcelain, or a radiographic abnormality found. The crown had to be sectioned for removal because it was tightly retained; no abutment mobility was noted. At evaluation of the new metal-ceramic crown 1 month after placement, no problems were documented (Fig 6).
Fig 3.—Metal ceramic crown, 5 weeks after cementation. (Reprinted from Tarlow JL:The effect of adult growth on an anterior maxillary single-tooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Fig 5.—Ten years 7 months following cementation. Compare with Figures 3 and 4 the position of the incisal edge of crown relative to the natural unrestored lateral incisor. (Reprinted from Tarlow JL: The effect of adult growth on an anterior maxillary single-tooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
continuing growth of the facial skeleton appeared to be the most likely reason for this shift in position, which required removal and replacement with a new crown.
Fig 6.—New metal ceramic crown inserted. (Reprinted from Tarlow JL: The effect of adult growth on an anterior maxillary single-tooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Discussion.—A metal-ceramic crown cemented on a single implant abutment changed position over the course of 10 years in a patient who was age 28 at cementation. The
Clinical Significance.—The perils of placing implants in patients who are still growing has been well documented, but this study reports a similar problem in a 27-yearold subject. Continuing skeletal growth is suggested as the likely cause of the observed changes.
Tarlow JL:The effect of adult growth on an anterior maxillary singletooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004 Reprints available from JL Tarlow, Dental Service, Dept of Veterans Affairs, New York Harbor Healthcare System, 423 E 23rd St, New York, NY 10010; fax: (212) 951-3378; e-mail: jeffrey [email protected]
Volume 50 • Issue 3 • 2005 139
Clinical Significance.—Being aware that not all problems presented by our patients have a physical basis and being able to discern those that do not can save both the clinician and patient much effort in the wrong direction. Bear in mind, however, that because a problem is not physical does not mean it is not real.
Jagger RG, Korszun A: Phantom bite revisited. Br Dent J 197:241-244, 2004 Reprints available from RG Jagger, Dept of Adult Dental Health, Univ of Wales College of Medicine, Heath Park, Cardiff CF14 4XY; e-mail: [email protected]
Implants Continuing facial growth changes crown position Background.—Osseointegrated root-form endosseous implants are generally avoided in children and adolescents who are still growing because of the ankylotic behavior of the implants. Adult facial skeletal growth has been documented to occur into the third decade and can produce similar problems with these implants. An apparent change in the position of a crown luted to a single implant abutment for about 10 years was reported. Case Report.—Patient, 27 years 2 months, had a missing maxillary left central incisor for which a 3.25-mmdiameter implant was placed. The surgery was performed in 2 stages, with the second at age 27 years 9 months. A hex-lock abutment was prepared and placed about 1 month after the second stage, then a metal-ceramic crown was cemented 2 months after that, when the patient was age 28 years. The crown was purposely placed out of occlusion with the incisal edge about 0.5 mm
138 Dental Abstracts
shorter than the contralateral central incisor (Fig 3) based on the limited experience of the clinician with the loading capability of this form of implant-supported restoration. The patient was examined 4 years 9 months later and then 6 years 11 months after the cementation; no problems were detected at either evaluation. Ten years 7 months after the cementation of the crown, at age 38 years, the patient came for an esthetic improvement in the crown because it “seemed smaller.” The crown position demonstrated an apparent change on the left central incisor, with the incisal edge nearly 2 mm shorter than the right central incisor (Fig 5). No loss of cement seal was found, nor was mobility, damage to the incisal porcelain, or a radiographic abnormality found. The crown had to be sectioned for removal because it was tightly retained; no abutment mobility was noted. At evaluation of the new metal-ceramic crown 1 month after placement, no problems were documented (Fig 6).
Fig 3.—Metal ceramic crown, 5 weeks after cementation. (Reprinted from Tarlow JL:The effect of adult growth on an anterior maxillary single-tooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Fig 5.—Ten years 7 months following cementation. Compare with Figures 3 and 4 the position of the incisal edge of crown relative to the natural unrestored lateral incisor. (Reprinted from Tarlow JL: The effect of adult growth on an anterior maxillary single-tooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
continuing growth of the facial skeleton appeared to be the most likely reason for this shift in position, which required removal and replacement with a new crown.
Fig 6.—New metal ceramic crown inserted. (Reprinted from Tarlow JL: The effect of adult growth on an anterior maxillary single-tooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004. Copyright 2004, with permission from The Editorial Council of The Journal of Prosthetic Dentistry.)
Discussion.—A metal-ceramic crown cemented on a single implant abutment changed position over the course of 10 years in a patient who was age 28 at cementation. The
Clinical Significance.—The perils of placing implants in patients who are still growing has been well documented, but this study reports a similar problem in a 27-yearold subject. Continuing skeletal growth is suggested as the likely cause of the observed changes.
Tarlow JL:The effect of adult growth on an anterior maxillary singletooth implant: Clinical report. J Prosthet Dent 92:213-215, 2004 Reprints available from JL Tarlow, Dental Service, Dept of Veterans Affairs, New York Harbor Healthcare System, 423 E 23rd St, New York, NY 10010; fax: (212) 951-3378; e-mail: jeffrey [email protected]
Volume 50 • Issue 3 • 2005 139