From hockey puck to full bite restoration.

Presenting concerns

• Trauma fracture of #19 (lower-left first molar) below the gumline — non-restorable.
• Adjacent teeth (#18, #20) intact and healthy. Bite stable.
• Patient otherwise healthy non-smoker. Good candidate for implant therapy.
• Strong preference to avoid a bridge — didn't want adjacent teeth crowned.
• No interest in flipper or partial denture during healing.

Treatment plan & timeline

1. Phase 1

   Atraumatic extraction & socket graft

   Visit 1 · Month 0

   Extraction of #19 root and bone graft (allograft + collagen membrane) to preserve socket volume for the implant placement four months later. 90 minutes total under local + oral sedation.

2. Phase 2

   Socket healing (no work done)

   Month 0-4

   Healing window. Patient came in monthly for clinical photos and no-charge check-ins. No flipper or temp — he chewed on the opposite side.

3. Phase 3

   Implant placement

   Visit 2 · Month 4

   CBCT-guided placement of a 4.7mm × 11mm Straumann BLT implant. 75 minutes under local + oral sedation. Cover screw placed, gum sutured over the top.

4. Phase 4

   Osseointegration (no work)

   Month 4-8

   Standard 4-month integration window for a lower molar. No issues, no pain, no complications.

5. Phase 5

   Healing abutment exposure

   Visit 3 · Month 8

   20-minute visit. Gum tissue exposed, healing abutment placed for 2-week tissue maturation.

6. Phase 6

   CEREC crown — same day

   Visit 4 · Month 8.5

   Digital scan, custom titanium abutment selected, zirconia crown milled in-office and bonded. 2 hours total. Bite checked and adjusted twice.

Outcome

At nine months post-injury, M.R. had a fully restored bite indistinguishable from his other molars. Insurance covered the extraction and partial graft cost; total out-of-pocket was $4,650 split across the year. Two-year clinical follow-up shows the implant integrated, the crown in good condition, and no peri-implant inflammation. He's wearing a custom mouthguard every game now.