The front tooth that had been root treated twice

The situation

An upper left central incisor, root treated in the late nineties and re-treated about eight years ago. It had gone grey by degrees, which he had lived with, and then started to ache — the sign of infection tracking out of the end of the root into the bone.

He arrived having been told by two dentists that the tooth had to come out, and having put it off for a year because the alternative he had been offered was a denture with one tooth on it.

What we suggested, and why

The tooth was not restorable. That part was not in question. The choice was between a bridge that would involve cutting down two healthy neighbouring teeth, a single-tooth denture, or an implant.

Cutting perfectly sound teeth either side to hold a bridge is a real cost that is rarely presented as one, and in a man of fifty-one those two teeth need to last another thirty-odd years. That ruled the bridge out for us.

The CBCT scan showed the infection had eaten into the bone at the front of the socket, so this was not a case for placing an implant at the same appointment as the extraction. We planned it in two stages.

What we did: single implant, upper front tooth

The tooth was removed as gently as we could manage — the aim with a front tooth is to keep the outer wall of bone intact, because that wall is what holds the gum up and gives the finished tooth its shape. The socket was grafted at the same visit and left to heal for four months.

At the second surgical visit the implant went in through a printed guide, with a temporary crown fitted the same day. That temporary is what shapes the gum over the following weeks; by the time Dr Mallon took the final scan, the gum line was already where it needed to be.

Marek made the final crown in the laboratory upstairs. The shade was taken in daylight against the neighbouring tooth, which is a thirty-year-old incisor with all the character that implies. It was remade once, because the first attempt was slightly too uniform.

Timeline

• Month 0 — extraction and socket graft
• Month 4 — implant placed, temporary crown fitted the same day
• Month 7 — final scan, shade taken
• Month 8 — final crown fitted
• Month 14 — review

What it cost

£2,850 in total: £2,450 for the implant, abutment and crown, plus £400 for the socket graft. The extraction itself was part of the same visit and is not charged separately for a single tooth. Paid in three stages, no finance.

The full price list is on the costs page, and the treatment itself is described on single tooth implants.

“I had convinced myself everyone would notice. Nobody has, including my sister, who notices everything.”

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