A patient makes an emergency appointment, and arrives at your clinic with her hand holding her cheek. You notice that her eyes look tired. An examination reveals a cracked upper right premolar and immediate extraction is required. Thirty minutes later, the premolar is removed and you begin to discuss what her options are.

Q: Do You? 

  • Offer an Implant: Go to section one.
  • Offer a Fixed Bridge: Go to section two.
  • Offer Dentures, Cantilever bridges, Maryland bridges and everything in between: Go to section three.
  • Offer nothing, but you'd love to read a story about Jill and see what happened to her: Go to section four.

Section 1: Implants

How you love implants, and you know that your patient will love them too!  You feel excitement brewing inside your chest when you think that you might get to use the skills you learned from the implant course you took last year. You educate your patient on all that you have learned about implants: how easy they are to care for, she can eat what she wants, she won't even know that they are there, and they will help to maintain bone and soft tissue density around the extraction area. You draw her diagrams and she enthusiastically agrees with you that it is a fantastic option. The conversation of cost begins, and you notice that her facial expression has changed: she looks shocked. Quickly you remediate the issue and explain your excellent in-house payment plans, but she is turned off. Your patient thanks you for the extraction, pays, and leaves your clinic. 

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Section 2: Fixed Bridge

After inquiring about her lifestyle, budget, and aspirations with her smile, you determine that your patient would find the cost of implants too much for her budget even with your fabulous in-house payment plan. You silently praise your skill in building fixed bridges and you imagine building one for your new patient. You do your best sketch to describe how fixed bridges are built and placed and your patient marvels at how perfect this option is for her. You discuss the price and she agrees to it as long as she can pay for it over the next four visits. Fantastic! You book her in for her first appointment. 

At the next appointment your patient arrives and cheerfully shows you how well her extraction wound has healed. You begin your examination, take necessary X-RAYS, and carefully examine her abutment teeth. Oh no! You discover that her bone density is not adequate, she has insufficient crown-to-root ratio in her abutment teeth, and the amount of periodontal disease you discover concerns you. 

You tell her that you have decided that don’t want to build her a fixed bridge after all, and suggest that she begins a program to attend to her periodontal disease. You assure her that you will reassess her situation after she improves her oral hygiene, and look forward to exploring the option for a resin bonded bridge. Your patient's face looks offended and disappointed. She curtly thanks you for your assessment and leaves the clinic.

Section 3: Dentures, Cantilever bridges, Maryland bridges and everything in between.

You describe to your patient the many options that you can offer her, and know that one will be perfect. Your patient notices how cheerful you are when you describe all of the options. “See”, you say, “There was a time that I didn’t know many options at all, except for implants and fixed bridges. Then I watched the Dr Michael Frazis masterclass. He is one amazing dentist who has gone really deep into this stuff, and showed me how many incredible options there are.”

Your patient looks at you like she is so relieved that you are her dentist. “The masterclass really opened my eyes", you continue. "Since then I’ve honed my craft, and I have to say, I love the results that I have been getting with all of my patients. I’m creating quite the name for myself. You are one lucky patient!” 

Your patient nods her head in agreement. She trusts you. You know she will love the journey you are about to go on together to restore her oral health and smile. She will be your patient forever. 

Section 4: A story about Jill.

This is a story about Dr Michael Frazis' first patient Jill, whose case set off his "avalanche of education". She is one of the first patients Dr Frazis documented thoroughly. Jill first saw Dr Frazis back in 2015 for a broken tooth upon which he placed a crown.

After that Dr Frazis and Jill did a few smaller fillings and got to know each other. They always spoke about improving her smile but her finances would never stretch that far.

A few years went by without any issues when suddenly Jill arrived at the clinic with a broken upper premolar. It was a tooth that Dr Frazis and Jill originally wanted to crown but life and finances got in the way.

Dr Frazis was learning to place implants at the time and he was excited to offer her a discounted
implant. Jill, however, was not overly fond of dental treatment and an implant - even a discounted one, didn’t appeal to her.
This, in combination with her small mouth, meant Dr Frazis had to find alternative options.

At the time Dr Frazis was reading old prosthodontic journals, text books, and having monthly catch ups with his prosthodontist to discuss cases.

Dr Frazis met with Jill to propose an extraction of the tooth and place a long term temporary bridge to shape the gum tissue for the future pontic site. When Dr Frazis met with his prosthodontist to discuss the case, they both realised that there weren’t a lot of resources out there for other dentists to explore these kind of procedures. They developed what they called non-implant replacement options.

Meanwhile Jill was having issues with healing after her extraction and so they delayed the
temporary bridge. In hindsight Dr Frazis decided that this was the wrong approach as he needed to have debrided the socket better after the extraction and placed the temp from the start. There were
bone fragments that had to be removed and cleaned out over multiple appointments.

In the end it made little difference other than delaying the final bridge but the techniques
and problem solving he learnt from Jill's case paved the way for future cases to become even

Have you had a case where you wished you mastered the many implant replacement options?

Dr Frazis wants to share his years of practice, education, and experience with you so that you can quicken your own learning journey and become the best dentist you can be.


RipeGlobal's Virtual Dental Residency in Modern Implantology