Q. Dear Dr. Caplan, I am currently having my teeth straightened using Invisalign and will be doing so for the next 8 months. My teeth have become crooked over the years (I am in my late 20’s) as a result of a baby tooth that has been stubborn and remained in my mouth. As such, I am straightening the teeth and then want to remove the cause of the crookedness (i.e. the baby tooth). I’m therefore thinking of removing the guilty tooth and inserting an implant into the jaw. The tooth in question is my upper Canine (I think it corresponds to number 6 on the dental charts). I have read quite a bit of literature but am hoping you can answer some of my questions if possible. 1.) I’ve been told that I will need to wear the final aligner in the Invisalign set for a good 3-6 months to ensure the teeth have time to settle in their final position. Assuming the baby tooth survives the forces from the Invisalign treatment, can I use these 3-6 months to remove the baby tooth and immediately fit the implant into the created hole (I read the treatment would need 3-6 months for the titanium implant to bond with my bone)? If this is so, can I then have the canine position on the inside of the aligner coated white, to look like a ‘fake’ tooth? My reason for this query is that the canine position will be very visible and I was hoping I could use the aligner to help mask the gap in my teeth! 2.) Having looked at implants, I would like an experts opinion on the use of modern all-ceramic crowns for implants. I like the look of the CEREC based crowns using Mark II blocks. However, I don’t know how much of my interest is just down to Vita’s good marketing and whether there are better alternatives on the market! If there is, I would very much appreciate your advice on the subject! What are your opinions of PFMs? 3.) Do you happen to know how much the process would cost with an all-ceramic crown in the UK? 4.) Could you recommend a decent dentist in the Cambridgeshire area that do ceramic crowns + implants? 5.) How common is it for UK-based dentists to stain the CEREC restorations and is this part of the normal procedure or does it cost extra? Thanks so much for the advice!

A. My advice would be definitely to have your baby tooth removed during the retainer stage of your invisalign provided you have had a proper assessment for the implant treatment – enough bone and space.  Although I am an advocate on Cerec and infact lecture world wide on the subject, I would advise a laboratory made crown as they are made on the implant analogue and will be the most accurate restoration.  In my paractice we charge in the region of £2600 for implant and crown.
Hope this helps.

Dr Julian Caplan
Aviva Cosmetic Dentistry
Director on the board of the British Academy of Cosmetic Dentistry
www.avivacosmeticdentistry.co.uk
101 St. Peters Street
St. Albans Hertfordshire
AL1 3EN