1 year Esthetic Success Story

When it comes to front teeth, especially the upper ones, the look, shade, size of the tooth & gum contour around the tooth, all play a significant role in complementing the esthetics. Replacing a single upper anterior tooth is a challenge even to the most accomplished dentists.

He walked in with mobile upper right canine (23). On examination we found a vertical fracture. We planned to extract it & place an implant & load immediately.

We gave a local infiltration at 23, extracted it as atraumatically as possible (this is especially important, preserve the buccal plate). We placed a Compressive One-piece implant, 3.75 / 16mm in the palatal wall. The abutment was then bent to the desired prosthetic position. Impressions were made & shade selected.

In 3 days, we cemented a Porcelain fused to metal crown. Check x rays were taken to ensure a proper fit of the crown.

One year later, the patient came for his lower front teeth replacement. I took a picture of the upper canine. It was such a pleasing sight. The gingival tissues have matured so beautifully, we have thick band of keratinized tissue around the implant, the papilla have creeped up with good health, despite poor maintenance of the patient (sometimes despite our best efforts, it is difficult to control this aspect)

Discussion:

Does, Implant design have a bearing on the esthetics?

I don't think so. I believe, esthetics is purely a result of available tissues (bone + gingiva). An adequate presence of bone & soft tissue ensures a good esthetic result when the abutment position is ideal. I have treated so many such cases without any bone grafts & have had excellent outcomes such as we see in this case.

One-piece implants offer us a better solution when it comes to esthetics.

1. We can engage good bone, which is often palatal & at the same time we can have good abutment position because of the bendability of abutment.

2. The abutment margin & the implant threads are far away, reducing the any chances of excess cement creating havoc (does not mean we do not clean the excess)

3. The abutment junction is not disturbed repeatedly like it happens with 2 piece implant system, we must do impressions, healing collar, metal trial, bisque trial etc.

4. No screw access holes to deal with.

When we understand the implant design & the bone, we can achieve excellent esthetic results.

What do you feel? Do comment & let me know.

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