CDE0111

20 I I special _ implants _Mandibular incisors can be vulnerable to earlylossduetotheirinherentlyweakperiodontal support and high prevalence with respect to peri- odontal disease. What are the most common treatment options for missing mandibular inci- sors? Aside from removable prosthetic options, the restorative options for a fixed prosthesis include a conventional bridge, a resin-bonded bridge (Maryland Bridge) and implants. For a case in which one or two mandibular central incisors are missing, a three- or four-unit bridge has often been the treatment of choice. A resin-bonded bridge,inthesecases,canbeareasonablealterna- tive to a conventional bridge; whereas implant treatment,moreoftenthannot,isnotsuitabledue to insufficient space. When more than two inci- sors are missing, the implant option may become the first choice for most clinicians these days. Preparingmandibularincisorsforbridgeabut- ments is an extremely delicate procedure that often leads to root-canal treatment due to pulp damage that might occur during the procedure. Even without the risk of pulp damage, it is still quite a challenge to recreate natural contour and shade on such tiny dentition. Dental implants have, in many cases, become the treatment of choice for restoring missing teeth and have been documented to have a high degree of success. With implant therapy, the preparation of healthy teeth adjacent to the edentulous area can be avoided. An additional advantage to the implant restoration is the main- tenance of the alveolar bone, which otherwise would undergo resorption with other restorative options, hence, often complicating aesthetics. What’s happening in the real world? Are we comfortable enough placing implants in the mandibular anterior region? In spite of under- standing both the disadvantages of conventional fixed bridgework and the advantages of implant restorations, we often make the treatment choice for missing mandibular incisors in favour of the bridge. Why is that? What hinders us from pro- viding an implant option for patients in such cases? Restoring mandibular incisors with im- plants can be one of the most difficult dental cosmeticdentistry 1_2011 Restoring missing mandibular incisors with implants— What makes you hesitate? Authors_ Dr Chonghwa Kim & Sangwoo Lee, Korea Fig. 1_Pre-op. Fig. 2_Pre-op peri-apical X-ray. Fig. 3_Resin-bonded provisional restoration. Fig. 4_Lingual view. Fig. 1 Fig. 2 Fig. 3 Fig. 4