Patient Problem
A female, older adult patient presented with a missing lower right first molar (tooth #46). The tooth had been absent for approximately five years, and the patient previously used a removable partial denture. However, the denture was discontinued due to discomfort and difficulty with chewing.
As per her medical history, the patient had no signs of active infection, no history of parafunctional habits, and adjacent teeth (#45 and #47) were intact and healthy. Clinical examination revealed she has a stable occlusion and adequate keratinised mucosa at the edentulous site.
While she had no history of parafunctional habits and no signs of active infection, the patient has controlled hypertension. She was also a non-smoker, had no history of diabetes or bisphosphonate therapy, and was classified as ASA II.
Proposed Diagnosis & Treatment Plan
A Cone-Beam Computed Tomography (CBCT) scan confirmed excellent bone volume for implant placement, with sufficient ridge width (7.5 mm) and height (12 mm) and favourable bone density. Based on these findings, a single-tooth dental implant was recommended to restore function.
Here are the steps recommended for the patient’s treatment plan:
- Surgical placement of a titanium dental implant at site #46
- A healing period of 10–12 weeks to allow for osseointegration
- Restoration with a custom abutment and screw-retained zirconia crown
- Regular follow-up appointments to monitor healing and prosthesis integration
Treatment Procedure
Appointment 1 (Surgical Phase)
After local anaesthesia was administered, a minimally invasive, guided surgery was performed. A 4.0 × 10 mm titanium implant was precisely placed into the jawbone, achieving excellent primary stability. A healing abutment was placed to shape the gums during the healing period, and the patient was provided with standard post-operative instructions.
Healing Phase
Over the next 12 weeks, the site healed uneventfully. Clinical and radiographic review confirmed successful osseointegration of the implant.
Appointment 2 (Prosthetic Phase, 12 weeks later)
After confirming successful integration of the implant with the bone, the prosthetic phase began. The healing abutment was removed, and an impression was taken to create a model of the implant’s position. A custom abutment and a screw-retained zirconia crown were fabricated by a dental laboratory. At the final appointment, the custom abutment and crown were fitted, torqued to the manufacturer’s specifications, and meticulously checked for fit and occlusion.
Outcome and Follow-Up
The patient was monitored to ensure the long-term success of the restoration.
7-Day Follow-Up
The soft tissues around the implant were healthy, and the patient reported no pain or complications. The crown was functioning well, with good adaptation to the surrounding tissue.
6-Month Follow-Up
A clinical examination confirmed the stability and health of the implant. Peri-implant probing depths were healthy (≤3 mm) with no bleeding, and radiographs showed stable crestal bone levels. The implant successfully restored normal masticatory function in the posterior quadrant. The patient also reported improved chewing efficiency and greater satisfaction compared to her previous removable denture.
Clinical Discussion
This case demonstrates the use of a single dental implant to restore a posterior edentulous space. The patient’s bone quality and general health also contributed tremendously to the success of the treatment. Aside from that, a surgically-guided approach using the Cone-Beam Computer Tomography scan was used to reduce postoperative discomfort and promote faster healing.
The decision to use a screw-retained zirconia crown allowed for retrievability and optimal load distribution. Moreover, the patient was also recommended to religiously follow regular follow-ups to ensure the implant remained healthy and stable.
This case highlights the importance of proper diagnosis, treatment planning, and precision in both surgical and prosthetic phases for successful long-term outcomes in implant dentistry.
Disclaimer: The information provided on this website is for general educational purposes only and is not intended as a substitute for professional medical or dental advice, diagnosis, or treatment. Always seek the advice of your dentist or other qualified health provider with any questions you may have regarding a medical condition.
Important Note on Surgical Procedures: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.