Extreme Dentistry For Those Willing To Go The Extra Mile by Dr Chan Joon Yee Surgical site after first attempt to place Bicon implant. Bone graft was placed instead. This extremely kind and forgiving female patient had a missing upper front tooth for more than 10 years. As the ridge around the area of the missing tooth was rather resorbed and the space available for the replacement tooth was too small, we recommended a fixed bridge to her. However, the patient was most unwilling to have her perfectly healthy neighbouring teeth trimmed to support the replacement tooth. She was keen on trying out implant restoration. On our first surgical approach, we discovered that the ridge was even thinner than we expected. We were unable to place the smallest 3.5mm Bicon implant we prepared as the bone was so thin that it broke off while we were preparing it. With the patient determined to let us try again, we proceeded to graft the defect with a particulate bone graft material and waited for 6 months. During the waiting period, she was referred to our colleague, orthodontic specilaist Dr Tan Lam Seng to open up the gap for a more satisfactory restoration. Surgical site 3 months after placement of Osstem implant On our second surgical approach, we noticed only a 1mm increase in bone width and decided to place a 3.5mm Osstem GSII implant instead. In spite of the lack of bone, the Osstem implant was remarkably stable. Another bone graft was placed to cover the areas where the implant has pierced through the bone. 3 months later, it was found that even though the bone graft was successful, gum tissue growth around the implant was not satisfactory. If the crown were to be contructed over the gums in this condition, unsightly metal will be visible under the crown. The collar of gum tissue around the crown would also appear too thick. The patient was kind enough to allow us to do cosmetic gum surgery to help us achieve a better result. Taking advantage of the thick collar of gum tissue, we split the flap and advanced it over to the the healing abutment. Surgical site after gum surgery. Healing abutment in place. After the patient's gums have healed, we called her in for impression taking. She was so relieved that there would be no more surgery. Below is a picture taken when her final crown was successfully fitted. We gave the crown a slightly lighter colour in anticipation that she might want to whiten her teeth in future. Surgical site has healed. The crown is cemented.