A novel approach for a single-tooth provisional.

T here is probably nothing more disheartening for dental patients who have meticulously cared for their teeth their entire life than to learn that a maxillary central incisor is hopeless and must be extracted. As clinicians, we are not only highly empathetic and concerned for the patients' aesthetic and functional concerns , we also realize that the road to restoration can be filled with a series of complex procedures, often entailing a multidisciplinary approach that could easily take several months to complete. A 45-year-old female patient presented to our office as a new patient with no dental concerns other than to become an established patient of record after recently moving to the area. A comprehensive examination including periodontal charting, intrao-ral photographs, and a full-mouth series of radiographs was performed. The patient was not in pain, and her primary dental concern was to remain current with her biannual prophylactic recare visits. Upon examination, tooth No. 9 exhibited Class I to Class II mobility with all other visual findings being within normal limits (Figure 1). In her medical/dental history, she indicated that, as a teenager, she had an accident that displaced teeth Nos. 8 and 9, and tooth No. 9 had required root canal therapy after becoming nonvital. Several cracks in both teeth were observed during the visual exam with tran-sillumination, but none were symptomatic. Closer inspection of the periapical radi-ograph clearly indicated that tooth No. 9 was in a state of active internal resorption and the tooth was diagnosed as hopeless (Figure 2). When the patient was informed that the diagnosis for her maxillary left central inci-sor was hopeless, she was heartbroken. Since her surrounding dentition was caries-and restoration-free, surgical extraction, possible bone and soft-tissue grafting, and implant placement were recommended. Though she had the economic means to treat the condition optimally , her primary concern was, " What will I do without a front tooth until treatment was complete? " There is no doubt that provisionalizing a single anterior maxillary tooth immediately, following the extraction and throughout the healing phase, for aesthetically and functionally demanding patients is a conundrum. No patient wants to go without a maxillary anterior tooth during any phase of treatment; and for many patients , wearing a temporary removable partial denture for months is unacceptable. Additionally, in order to gain ideal gingival architecture replete with properly supported papilla after implant placement demands that the provisional be …