A permanent solution when permanent teeth don’t erupt
Typically a patient will lose primary (baby) teeth as the permanent teeth in the bone below develops and matures, pushing the primary tooth out of its way. In the case where there is a congenitally missing permanent tooth, the primary tooth may be retained for an indefinite period of time. However, in the case of a retained primary baby tooth, it is common that the roots of the primary tooth degrades into the bone and becomes loose, ultimately needing to be replaced with either implant dentistry or crown and bridge dentistry.
Prior to meeting me, this patient had some of her retained baby teeth replaced by a bridge (upper left) and others replaced by implants (lower left). She was experiencing problems with both types of restorative solutions with packing food around the gum-line. The core issue was that the restorations had not accounted for the difference in width between the missing permanent premolar, and the retained primary tooth. As a result, the emergence profile was not symmetric between the remaining teeth, and food was getting trapped between the restorative material and the gums. We redesigned the lower implant crowns, to create a healthy symmetry at the gum-line (see X-ray). We also replaced the upper bridge with implant-crowns, designing the full adult contour of what her permanent teeth would have looked like. She can confidently chew with the new implant crowns as though they were her own teeth.
For more cases like this, see our FlickR page at https://www.flickr.com/photos/drcaughey/sets/