Ethical issues in replacing a single tooth with a dental implant

A general dental practitioner experienced in the placement of dental endosteal implants attends to a 32-year old female patient at her first consultation and treatment planning visit. The patient's oral hygiene was exemplary, her dentition restoration free except for the left central incisor which was non-vital following trauma several years earlier. The tooth had internal resorption, was mobile, had a resorbed apex, was symptomatic, and is by the practitioner's judgement indicated for extraction. The dilemma then was, what were the options for tooth replacement? Treatment options included: a removable partial prosthesis with a single tooth (acrylic, chrome cobalt), fixed multi-tooth partial prosthesis (porcelain, composite, porcelain-metal), fixed single tooth (porcelain, porcelain-metal), or an endosteal implant - supported crown (screw retained, cement retained). The dentist recommended extraction and immediate placement of an implant with a provisional crown. The patient was not comfortable with the idea of having a 'titanium screw' in her jaw and expressed her deep-seated fear of dentists. The cost of this treatment option was also a concern but she was grateful to be able to have the treatment in a single visit and leave without a missing front tooth. At an appointment soon thereafter, the incisor was removed an endosteal implant placed together with an implant provisional tooth in place.DHE