Rebuilding a Single Tooth Front Dental Implant

In the dental world they say that a single tooth dental implant is one of the hardest things to get right.

I would say that there are harder things, but its really hard!

Here is a case we recently completed.

The Situation

Here, one front tooth is missing, the second photo is just a close up of the first.

I have marked where the dental implant is, and during the consultation we discussed the final appearance of the smile, and the goal was a natural and neat looking smile.

In this case, the patient already had an implant placed (we normally hate this, because if the position of the implant is slightly out, it can make a good end result pretty much impossible).

In this case, the position was fine, we did need to make one compromise because of the position, but it didn't effect the aesthetics.

Right now, the patient has a bridge to cosmetically replace the missing tooth, and this is glued to the other central tooth. Area 1. is the join, and you can see the glue holding the bridge between the teeth.

Area 2. is a dark area that the patient dislikes, this is a slight defect in the tooth shape, and can easily be fixed with some composite material.

Even in Area 1 - once we remove the excess material, the tooth will not be a great shape, so we planned to reshape this tooth with composite too.

The Constraints

The biggest constraint here was keeping the overall treatment cost within limits - so we needed to prioritise the most important aspects, and keep focused on the ideal end goal.

One thing that was out of the question was a connective tissue graft.

When we lose a tooth, we lose gum volume in that area, so the area can be sunken in. This makes the tooth look bulky in that area (because the gum is sunken)

If we were to do this case from the start, we would place a dental implant, do a bone graft and possibly a tissue graft at the same time, so that we maintain volume. But this is extra cost and extra time.

Instead we were clever(ish) about how we uncovered the dental implant, and when we put a temporary tooth on it, we used the temporary tooth to support the gum.

It kind of worked - and because his smile isn't too high, we can get away with it.

What we cant get away with is the shape of the tooth, so we spent about 90 minutes to make a temporary tooth on the implant, so shape the gums.

Temporary tooth to shape the gum

At this stage, we have done the composite bonding (remember areas 1 and 2?). In addition, the temporary tooth has been in place for a few weeks.

After any gum work, things always look great after a few weeks, but the gums will often shrink back a little over time.

Anyway, at this stage, we are almost there - we just take our records and have about 2-3 "try in" appointments, where we double check the shape, the colour and the bite.

We hardly ever get it right the first time - eventually we get there!

These are the final photos - but after taking these, we did flatten the bulge on the left front tooth (as we are looking at it).

If I am being picky, there are a bunch of differences, but these are minimal. The colour, and the texture of the new tooth is very close to being natural, the composite is invisible, and we achieved this within budget - although I think we overshot the time taken to get to the end result!

These photos are taken on the day of the fit, so I expect the gum to look nicer over the next few months.

A lot of people will pay a lot of attention to the colour, and yes, this is important, but look at the vertical ridges on the teeth, this is normal anatomy, and building this into the final teeth really helps the teeth to reflect light in a natural way - helping make this manmade tooth look more natural.

The goal was to make a natural looking tooth, and teeth should look similar, but they are rarely perfectly symmetrical, so I think we achieve the goal.