30 year lovely young lady had traumatic accident that fractured and mobilized max incisors 6 years ago (2014). Once the incisors were stabilized then endodontic therapy was completed on teeth #'s 8,9,10 and in Feb 2015 new restorations were cemented. Root resorption started in 2018 and she eventually lost the three teeth which had RCT. She wore a essix retainer and then a removable acrylic partial denture to provide anterior teeth to restore her smile ( cingulum rest on the cuspids) and the edentulous area was protected during bone grafting and dental implant placement. Two dental implants ( #'s 8,10) were place in 2019 and were completed submerged until integrated then they were uncovered with placement of custom healing abutments by the periodontist. A few weeks later dental implant # 8 became asymptomatic and was lost. More bone and soft tissue grafting followed and several months later another implant placement # 8 was attempted, but the bone was not adequate to stabilize the implant and the procedure was aborted and more soft tissue grafting was done. The patient is sick of surgery re dental implants and wants a solution to replace her incisors. She is direct about no more surgery and no more dental implants.

I have placed the images in sequence by date for background. The question is can I provide a fixed solution without preparation of the upper cuspids ( I dread that for sure)? I discussed sacrificing tooth # 7 to and place an implant in that site but she does not want to risk another surgical failure and wants to move on with restoration of her smile and her life. Your comments and suggestions appreciated.

June 2014

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Feb 2015 Restored incisors

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Nov 2018

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June 2020

[image:PA_xray_7_10_area1.jpg][image:PA_xray_7_10_area2.jpg][image:6_10_20_smile_images_4.jpg][image:6_10_20_smile_images_6.jpg][image:6_10_20_smile_images_3.jpg][image:6_10_20_smile_images_5.jpg][image:6_10_20_smile_images_2.jpg][image:6_10_20_smile_images_7.jpg]