Earlier this August, I wrote a blog as a second instalment on an anterior implant case. The patient lost her upper left front tooth due to a severe cavity in the root (caused by external resorption). Subsequently, the tooth was extracted, and a Straumann BLX implant was surgically placed in the extraction socket. An exogenous bone graft (freeze-dried bone particles from another human being) was placed around the implant. To keep the bone graft particle intact and to prevent the soft gum tissue from penetrating among the bone particles, a piece of collagen membrane was placed over the particles and sutured in place.
A few months have passed for the implant to be integrated into the jaw by the newly formed bone. A temporary crown was made to attach to the stabilized implant.
The last post ended with a photo, see below, of a temporary crown attached to the patient’s implant on her upper left side.
Since then, a few changes have been made to the patient’s front teeth that dramatically improved the aesthetics.
First, the space between the two upper front teeth was too prominent, resulting in a large black triangle. To address this issue, I bonded composite resin to her natural tooth on her right side (your left when you look at the photo) and modified the temporary crown on the left to make them more symmetrical and pleasing.
The results were much more attractive than in the beginning. However, the length and shade of the temporary crown were not pleasing enough. Improvements were still needed before the final crown could be processed.
The modification process continued for a few months as the patient interacted with me to let me know what she liked. The complications I have to face are that the old bridge has a different shade and translucency than her other teeth, and the lateral incisor of the bridge is a bit too long. It made it harder for me to create a harmonious transition from her natural teeth on the right side to the bridge on her left with my temporary crown in the centre. After many changes and alterations, we finally have a decent appearance.
After six months of healing the implant and teeth adjustments, the patient and I were happy with the results. Then I made a final crown with titanium, zirconia and lithium disilicate.
During the fabrication process of the final crown, it was also modified a few times before the results were deemed satisfactory. The final crown was attached and tightened to the implant with a screw.
The response of her gums to it was excellent. Her smile has not just been restored but improved.
Before and after composite resin bonding and an implant-supported crown.
The patient is delighted with the results. I will let the gums around the implant crown heal for 2 to 3 months before performing gum augmentation to improve the appearance of the soft tissues further, especially the interdental papilla.
