implants UK - the journal of oral implantology

42 I I clinical _ sentimental tooth implants1_2011 ofthereluctanceofthepatientnottohaveadenture, boththedentistandthepatientarewellmotivatedto ensure the patient avoids this situation arising. However, from the surgical photographs a large labial defect is evident due to the failed UL1 bridge abutmentthathadpreviouslybeenextracted(Fig.10). A labial defect with a large cystic lining could be seen in the position of the UL2 (Figs. 11 - 12). This again presents a problem when plac- ing implants to supply the patient with another fixed bridge. This is likely to be a classic case of the ‘sentimental tooth’ whereby the patient was highlymotivatedtoavoidhavinganotherdentureand the dentist was doing their best to ensure this situa- tionwasavoided.Hencethehistoryoftreatmentseen intheUR2andUL2.However,theredoescomeapoint wherethedentisthastomakeajudgementinatimely manner if the original plan did not succeed. When the patient came to us his original intention wastohaveoneimplantinordertoretainabridgecan- tileveredfromittoreplacetheuppercentrals. Iadvised him that the condition of the laterals was not good and it was likely that in the next five-10 years they wouldfail,creatingfurtherproblemsinthatareaofhis mouth. I gave him the option of having a fixed Nobel Replace implant retained bridge from UL2 to UR2 (Figs. 13 - 14). After some consideration he decided toproceedwiththiscourseoftreatmentwhichwould mean the removal of historical treatment, along with its potential problems and a fresh start. _Conclusion Asstatedatthebeginningweallcomeacross the situation where we are treating these so- called sentimental teeth. We all practise, to a greater or lesser degree, ‘herodontics’ where we do our utmost to please our patients delivering what may seem at the time to be the best treatment we can offer. When considering whether or not you havereachedthisstageyoumustaskyourselfwhether keeping the tooth with further treatment is going to benefit the patient in the long term, and whether the risksandbenefitsweighup.Orareyousimplydelaying theinevitablelossofthetoothwhilstpayingaclinical pricethatmaycompromisefuturetreatmentafterthe tooth has been lost. If the answer to the latter is ‘yes’, mayIsuggestthatthepatientbereferredforadispas- sionate second opinion_ Fig. 11_: Defect with aspirator tip Fig. 12_: Pre-op PA of the UR2 Fig. 13_: Pre-op PA of the UL2 Fig. 14_: Defect of the UL1 and UL2 implants Dr James Main BDS(Edin) MFGDP RCS(Eng) Dr James Main quali- fied from Edinburgh University in 1984. Dr Main started his career in Westminster Hospital in London thenspentaperiodintheRoyalNavy as a Dental Officer and has been in Private Practice since 1990 both in England and in the Caribbean. He has taught extensively and acts as a Mentor to other dentists wishing to use world leading Nobel Biocare dental implant system. Dr Main is the Principal of the James Main Dental Partnership and is primarily based at his Glastonbury practice in Somerset. _author info Fig. 12 Fig. 13 Fig. 11 Fig. 14