Dental implant reconstruction of missing teeth in the anterior aesthetic zone is a complicated and detailed procedure. As well as being, on occasion, technically difficult these procedures come with high expectations from patients and as a result must be managed appropriately. Reconstruction of missing teeth in the aesthetic zone is a procedure which requires excellent patient assessment, case planning, surgical execution and attention to prosthetic detail. At Campbell and Peace we routinely use provisional anterior crowns in order to achieve the optimum soft tissue result around implant restorations, and so provide the patient with the best achievable results. The following case is that of a woman in her early 20s who received a traumatic injury when her dog jumped up to her face and fractured her upper left central incisor tooth (figure 1). 

 

 

 

 

 

 

This happened within less than a year of the date when she was due to be married and was understandably upsetting for the patient. She presented requiring restoration of a single-tooth gap in the upper left central incisor region and her expectations were high. In such a case very careful planning is undertaken including photographs, radiographs, study models and, depending on the case, CBCT. Implants are placed to a strict protocol following extraction of the remaining teeth together with bone grafting using Guided Bone Regeneration in approximately 90% of cases. This provides a stable soft tissue result and excellent placement position for reconstruction. Once the implant site has healed (approximately eight weeks) it is then possible to expose the implant and construct a first stage provisional crown in a modifiable material (composite) to allow shaping of the gum margin (figure 2).

 

 

 

 

 

 

The ability to shape the gum margin depends upon the vertical bone height, position and support of the gingivae and the shape of the adjacent teeth. Another crucial factor is the thickness of gingivae or gingival biotype as it is described. Following appropriate maturation of the gingival tissues and modification of the crown as appropriate it is then possible to copy the emergence profile of the provisional crown using a specialist impression technique to “pick up” the shape of the provisional tissue (figure 3).

 

 

 

 

 

 

Once the detail is sent to the laboratory it is possible for a skilled technician to construct a crown with an excellent emergence profile to support both the mesial and the distal dental papillae in an ideal position to provide very acceptable aesthetic result (figure 4, crown at 1^st fitting). Note the small amount of black triangle present in the mesial interdental papilla area. If the procedure has been undertaken correctly with the sufficient amount of attention to detail it is possible to predict the final outcome following a small amount of maturation after final crown fitting. In this case the patient was fitted with an all-ceramic crown in the upper left central incisor region in time for her wedding and was delighted with the overall result (figure 5).

 

 

 

 

 

 

For more information on aesthetic implant placement please contact Colin Campbell at colin@campbellandpeace.com. All surgical and restorative work carried out by Colin Campbell. Permission for use of these images has been obtained from the patient.