Chief Concern: Shea was unhappy with her gummy smile and her maxillary central incisor (#9) with previous root canal and apical surgery. She had discomfort when biting and a root fracture was suspected.
Treatment Received: Prior to surgery, we fabricated a two-tooth, fixed acrylic temporary for teeth #8-9. In one surgical visit, Shea’s gummy smile correction was completed with immediate extraction and an implant in site #9 with hard tissue grafting to preserve her esthetics. A smile makeover was commenced three months later with porcelain veneers on her other seven upper teeth in her smile zone.
Chief Concern: Patty was unhappy with her smile due to the crowding of her upper and lower front teeth. She was aware of needing to lose her front tooth (#9-her left central incisor) due to severe root resorption.
Treatment Received: To enable a final pleasing esthetic, result our team orthodontist treated Patty in 8 months with Invisalyn® to correct her crowding for proper implant site development.
The tooth was then removed and in a coordinated appointment with her advanced restorative dentist, a fixed screw-retained provisional crown was inserted to act as the “blueprint” for the final crown (“immediate contour management”). The final screw-retained crown was completed 3 months later.
Chief Concern: Mike wanted to immediately replace a fractured front tooth (#8-rightcentral incisor) with a dental implant. He fractured the tooth playing hockey the day prior after a “high sticking” incident.
Treatment Received: In one surgical visit, the #8 incisor was removed and an immediate implant was placed with soft and hard tissue grafting. A screw-retained provisional crown was placed at eight weeks to sculpt the tissue with subsequent final crown placed for both #8 and bonding for the broken incisal edge of #9.
Chief Concern: Ali was unhappy with the esthetics of her maxillary central incisor (#9) which had a previous root canal and was failing due to severe internal-external root resorption from a previous car accident.
Treatment Received: Prior to surgery a two-tooth fixed acrylic temporary was fabricated for teeth #8 and 9 (central incisors). In one surgical visit, #9 was removed, an immediate implant placed using our Esthetic Zone Check List which we have published on to avoid esthetic complications. Both hard and soft tissue augmentation was completed at the time of implant placement. Eight weeks later, the fixed provisional was connected to the implant and made into single temporaries to “sculpt” the soft tissues and act as the “blue print” for the final crown. This important step of gingival “contour management” using a screw-retained temporary crown is used by our team for all esthetic zone cases to achieve a predictable esthetic result as part of our “10 Keys” check list. Final Crowns were fabricated once the whole team was satisfied with the soft tissue sculpting for both #8 and a screw-retained implant crown for #9.
Levine, RA, Ganeles, J, Kan, J, Fava, P, 10 Keys for Successful Esthetic-Zone Single Immediate Implants- Importance of Biotype Conversion for Lasting Success, September 2018.
Chief Concern: Marcia had aesthetic concerns since she was missing her right lateral incisor (#7) and soon would lose her left lateral incisor.
Treatment Received: In one surgical visit, the #10 tooth was removed with single implants placed in both #7 and #10 sites with hard and soft tissue augmentation. Final crown restorations for #6 through #11 was commenced four months later.
Chief Concern: Kip wanted to replace a fractured front tooth (#9 -left central incisor) with a dental implant. She’d had an implant placed years prior by Dr. Levine to replace a failing lower left, three-unit bridge.
Treatment Received: In one surgical visit, the #9 incisor was removed and an immediate implant was placed with soft and hard tissue grafting. A screw-retained provisional crown was placed at eight weeks to sculpt the tissue with subsequent final crowns placed for both #8 and #9 teeth.
Chief Concern: Audrey came in with two, failing, endodontically treated, maxillary central incisor teeth (#8, 9). She was very unhappy with her smile and was unable to bite on these teeth due to discomfort and tooth mobility.
Treatment Received: The two failing teeth were removed and implant site development was completed with hard and soft tissue augmentation. Single implants were placed three months later followed eight weeks later by fixed provisional crowns for tissue sculpting, followed by her final single crowns. At time of this writing, Audrey’s orthodontic therapy in her lower jaw is nearing completion to allow the placement of single implants in her first molar areas.
Chief Concern: Alicia had a high lip line and equally high esthetic demands. She was concerned that her #9 (maxillary left central incisor) was non-restorable.
Treatment Received: Orthodontic extrusion was completed over 12 weeks for #9 to help augment both the soft and hard tissues locally. The tooth was then removed, and an immediate implant was placed with soft and hard tissue augmentation. Alicia’s final crown was completed four months later.
Chief Concern: Shannon was concerned with the looseness of her two, upper primary canines and desired permanent single teeth. In addition, she was unhappy with her asymmetrical, gummy smile.
Treatment Received: In one surgical visit, we removed Shannon’s loose canines and placed immediate implants with bone grafting and correction of her gummy smile. Fixed, screw-retained temporary crowns were placed the following day and final crowns were made a few months later.
Chief Concern: Agnes had a non-restorable left central incisor (#9) due to dental decay. She was esthetically concerned with gingival asymmetry and the color of her incisors.
Treatment Received: The #9 tooth was orthodontically extruded to bring the soft tissue (gum line) and hard tissue (bone line) down. Upon completion of the process, the tooth was removed and an immediate implant was placed. Agnes’s final result shows gingival symmetry with single crowns placed on her four incisor teeth.
Chief Concern: Due to experiencing a mouth trauma as a child, Liz had severe root resorption of her central and lateral incisors.
Treatment Received: We placed a single central incisor implant with lateral incisor cantilever after bone and soft tissue reconstruction. A fixed provisional restoration was used prior to completing Liz’s case to sculpt the soft tissues.
Chief Concern: Phyllis had a history of periodontal surgery over the past 20 years and was concerned about her loose, unattractive teeth. She was looking for a smile makeover.
Treatment Received: Phyllis received complete mouth periodontal therapy with extraction of seven teeth and placement of six single implants with porcelain crowns and veneers on all her remaining teeth. She’s seen every three months for preventative periodontal maintenance. A night guard was made to protect her new smile.