While we strive to make sure that all the work we do is cosmetically pleasing, the importance of an aesthetically pleasing outcome is of the highest importance in the front of the mouth. Factors such as gum contour, gum thickness, available space, bite relationship and shade all come together to make it necessary to plan the case very thoroughly.

Variables include: What type of temporary tooth will be in place while the implant is healing and integrating with the bone?

What material should be used for the best combination of strength and aesthetics?

The following are some actual cases to illustrate what we do with different situations:

Single Missing Tooth:

single implant crown before
single implant crown after

This case represents common situation-a missing central incisor.  Because the bone present was excellent an implant was placed without any additional surgical considerations and then left to heal for 4 months while he wore a single tooth removal denture.  Once healing was complete we were able to take a simple impression and about 2 weeks later deliver the final abutment and crown and the case was finished.

Replacement of an Old Implant Crown:

single implant crown and single porcelain veneer before
single implant crown and single porcelain veneer after

This patient wanted to replace an implant crown that was done 10 years ago. As can be seen the shade is off but even more challengingly, the tooth was positioned forward.  It was done this way by the previous dentist and lab so that the size of the 2 central incisors would match-two central incisors of very different widths would be even more unaesthetic than a single tooth that is out of position. I worked with my lab to come up with a plan in which I would gain space from the lateral incisor next to it by shaving down the side in order to make it “skinnier” and then placing a porcelain veneer to restore the tooth to full function.  This gained us the space and then my dental lab made a custom abutment and a new crown to match the adjacent tooth.  Not only are the teeth much more in harmony the gums dropped down additionally as anticipated giving a more symmetrical and youthful appearance.

Missing Lateral Incisors:

2 implant crowns before
2 implant crowns after

This was a case where the patient was originally missing her lateral incisors ( a not too uncommon situation).  The canine teeth had moved towards the middle  and gave an unaesthetic appearance.  The first step was for the patient to undergo orthdodontics to create space between the central incisors and the canine teeth. Once this was achieved the oral surgeon placed 2 implants with extreme precision using a computer fabricated surgical guide. Once initial healing was completed we placed her in temporary crowns so that we could shape the gums and also make sure we had the proper dimensions for a nice aesthetic final outcome.  In cases like this, a trial temporary phase is crucial to consistently delivering a predictable final outcome.  Once we liked what we saw we took special impressions to transfer our information and the final crowns were placed as you can see on the right.

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