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Case of the Day: Missing Back Teeth

This case is a great example of minimally invasive implant placement using technology. This patient came in to our office stating that he had been missing his lower back teeth for a while and was interested in having implants placed to replace the teeth. Here is a screenshot of his 3D cone beam CT x-ray.

He is missing multiple back teeth, but has adequate bone for implant replacement. We discussed all of his options for replacing his missing teeth, and virtually placed the implants on the x-ray. Notice also we were able to trace the location of his Mandibular Nerve to ensure the implants stayed far away from the nerve.

Using this 3D x-ray, we are able to fabricate a surgical guide that ensures we place the implants exactly where we want them to go. The day of the implant placement we used a “flapless” technique that ensures minimal cutting and smooth healing.

The first image shows his jaw before we started. We then made a selective cut in the gums only where we needed for the implants. We made a pilot hole in the bone, and then enlarged it to the size of our implants. After placing the implants at the level of the bone, we placed healing collars to seal off the gums. These collars will remain in place throughout the 4-6 month healing process after which we will take impressions of the implants to fabricate individual crowns. The healing collars keep the gums from closing over the implants, so we don’t have to make a second cut in the gums to take the impressions.

This is a great case that shows some of the minimally invasive surgical techniques available to minimize the trauma of implant surgery. This patient had a great experience. He did not feel anything during the surgery (I never work unless my patients are completely numb), and said he didn’t need to take any of the prescription pain medication we gave him. The next day he referred his best friend for implant treatment! Minimally invasive surgery made that happen!

Do you have any questions? Any other topics you'd like me to address on this blog? Shoot me an email at and I'll either respond with an email or with another blog post.

Smile Again.

Jonathan Geleris, DDS, FICOI

Disclaimer and disclosures: I'm a dentist who performs dental implant treatments, and general dentistry in Walnut Creek, California. I don't work for any dental companies (other than my practice). Nobody pays me to write this. As much as possible, I hope to present factual information supported by solid science, however, humans are complex, and the science in this field is constantly evolving. Some of what I present may be based on my opinion.

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