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CLINICAL Creating Attached Gingiva is Mandatory for Dental Implants by Timothy Kosinski, DDS, MAGD O ur patient is a 43 year old female who presents with edentulous mandibular left first and second molars. She also desired to have her maxillary dentition esthetically restored with conventional crowns. It was imperative that the mandibular arch be restored to function and several options were provided including a removable partial denture. The patient elected to have the edentulous space restored with dental implants. She does have controlled Crohn’s diseas and microadenoma of her pituitary gland. Neither of these conditions contraindicate surgical placement of dental implants. As implant dentistry has become a prominent means of replacing missing teeth, several items must be addressed to ascertain whether a patient is indeed a candidate for this therapy. First and foremost the patient must be relatively healthy, meaning no uncontrolled medical problems such as uncontrolled diabetes, uncontrolled hypertension or immunosuppressive diseases. Secondarily there must be adequate height and width of bone to accept the dental fixture. If enough bone is not available then more invasive bone grafting procedures would need to be considered. There also must be a thorough understanding of the anatomy in the sites to be considered. The relative position of the mandibular nerve and mental foramen and the maxillary sinus in the maxilla need to be demonstrated. The current use of CBCT analysis helps in the three dimensional visualization of vital anatomy and can help the practitioner idealize each individual case. Modern, sophisticated implant design has made implant dentistry predictable with a long -term positive prognosis. Prioritizing prosthetic design prior to any surgical intervention can insure a functional and esthetic final result. There needs to be a clear visualization of the case finished prior to any surgical treatment. In this demonstration, our patient presents with an endentulous area in the mandibular left first and second molars. The mandibular second bicuspid needs a restoration. As is often seen clinically, there is significant vertical bone loss demonstrated in Figure 1. As teeth are lost, bone often shrinks vertically, but also horizontally toward the lingual. This bone loss will often result in the mucosal tissue following the bone, resulting in a lack of attached gingiva on the facial aspect of the edentulous site. 1 Continued on next page. Figure 1: Digital periapical radiograph illustrating amount of bone available in the mandibular left first and second molar area. FIGURE 2: CBCT analaysis demonstrates adequate bone height and width to accept dental implants 800-337-8467 www.myeidonline.com 47