Before and After 2019: Missing Tooth Replacement on Lateral Incisors (Part 1)
A Caucasian female patient in her 20s was introduced to me upon completion of extensive orthodontic treatment to create enough space to replace the missing laterals. It has been a long journey for the patient to get to the point having the implants on the laterals and hoping to achieve the smile that she never thought was possible.
There were a few technical challenges that I encountered:
- the angulation of the screw channels
- colour matching with the surrounding natural dentition.
1: Today, close to 100% of my implant restorations are requested as screw-retained rather than cement-retained. When the angulation of the implants are not ideal, then my primary choice is to use dynamic abutment – an alternative to the genuine Ti interface abutment – http://www.dynamicabutment.com
The dental technician/ceramist needs to to communicate with the clinician when the genuine implant components are not suitable to achieve what is aligned with the clinical philosophy. Ultimately, the clinicians must choose the genuine product with cement-retained restoration or screw retained with the dynamic abutment because they have the highest responsibility.
2: Lateral incisors’ colour matching with the surrounding natural dentitions should be aimed for the “blend-in” or “transition” from the central incisors to canines, with more influence from the central incisors’ value and level of characteristics. Canines have, almost constantly, the highest chroma – the intensity of the colour (i.e., the darkest in the mouth), and the central incisors are the brightest teeth in the dental arch in general.
For the best biocompatibility and natural aesthetics, the material of the implant restoration should be a combination of Titanium (for the strength) and Zirconia (for the aesthetics) as I presented in the blog post in Publication section (click here to read).
Figs 1-3 show the pre-op close up smile photos.
Figs 4-6 show the pre-op close up retracted photos.
Figs 7-9 show the post-op close up smile photos.
Figs 10-12 show the post-op close up retracted photos.
Note that I didn’t copy the colour of the central incisors 100%. Instead, I created something to achieve better harmony within the arch, as mentioned above.
The result shows that the natural aesthetics are achieved with the highest level of satisfaction from the patient.
I’d like to thank Dr Aden Tran from Mosman Fine Dental in Mosman NSW, Australia, for his clinical excellence.
This case was issued in December 2019 with no remakes.