I am ready to get implants for my congenitally missing lateral incisors. My gaps, #s 7 & 10, were considered too small for implants a few years ago. Now I have two surgeons that say that they could put implants in my space. I want to know which procedure and type of surgeon would best suit my case? I have an Oral Surgeon and a General Dentist (with an Implant Specialty) both willing to do my surgery. The procedures they would do differ.
Congenitally Missing Lateral Incisors. Now Want Implants
Doctor Answers (16)
Choose The Right Surgeon For Your Dental Implants
Be very careful who you choose to place your dental implants, ESPECIALLY In this VERY ESTHETIC AREA! First and foremeost there is NO Such Entity as an "Implant Specialty" this is not recognized as a specialty by the American Dental Association. BE VERY AWARE of anyone calling themself a "Dental Implant Specialist" A Board Certified Oral and Maxillofaical Surgeon is the most qualified individual for addressing your needs . I do stress the need for Board Certification. Board Certified Oral and Maxillofacial surgeons have the proper training and knowledge not only to place implants properly, but also have the needed training in dealing with complications. I see a fair amount of complication in dental implant placement by individuals without the proper training in dental implant placement. Just because someone takes a weekend course on dental implant placement, does not make them an expert. If you choose the wrong doctor the process can ultimatley cause you a lot of heartache as well as financial ache. As previously mentioned, bone grafting may be needed as well as some other tissue augmentation procedures so please choose wisely and don't be fooled by a "Dental Implant Specialist" or a "Dental Implantologist" which do not exist.
Congenitally Missing Lateral Incisors. Now Want Implants
Here are some of the factors that you need to consider when you want to decide if dental implants are good option to replace missing lateral incisors:
-are the roots of the adjacent teeth far enough apart to have room to place an implant
-is the width of the bone thick enough as you go from your lip to your pallet
-do the adjacent teeth have any gum disease or bone loss
If other factors are good but there is not enough bone then a bone graft may be required.
Hope that this helps,
Implants for Missing Laterals
Not all dentists will agree with my answer but I would not have implants placed in a cosmetic area such as this without a 3D cat scan done and a software design of the crown and surgical guided implant placement. This will assure the implant is placed properly with the tight space between the adjacent teeth and that the crown will be in the proper place for the best cosmetic result.
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Who should place dental implants in my smile?
One of the main factors for a dental implant to look very natural in a smile is the gum tissue surrounding the implant /tooth. When I am dealing with implants in the esthetic zone (smile) I prefer to have the implants placed by a periodontist. A periodontist is a dental specialist that specializes in gum health. I would recommend that you ask your dentist for a referral to a periodontist that can show you before and after photos of implant restorations in the esthetic zone. You should also make sure that your dentist is trained in cosmetic dentistry and has his or her own smile photo for you to review. The largest organization for cosmetic dentistry is the American Academy of Cosmetic Dentistry and they have may great resources for the general public. Do your homework at AACD.com. Good luck on a beautiful smile!!
Don't make a quick decision!
Your case may seem simple but it can be very demanding. Here are the factors to consider: What is the height and width of the underlying bone at #7 and #10? What is the space between the adjacent teeth? What is the thickness of your gum tissue in these areas. (Bio-type)? What is the distance between the roots of the adjacent teeth? How high does the lower edge of your upper lip go when you smile broadly?
Now for the answers. The correct artistic width of your lateral incisor should be 2/3 the width of your centrals. The space between the roots of the adjacent teeth should be at least 5mm to accommodate a 3mm implant. The facial bone between the teeth should not be "Caved in". Ideally, your gum tissue is medium to thick and not overly thin. The implant should be set back slightly towards your tongue to achieve what is called," Biologic width". This will insure that you maintain the bone that supports your gum tissue between the teeth so you don't get "Dark triangles" between the teeth. If all of the above are present and you find a dentist who is passionate and experienced, you will love the final outcome. Find someone who has done many implants on the front teeth and understands the importance of little details. I hope you have wonderful result.
As someone that does a lot of implant restorations, my advice would be to be very careful in choosing the doctor to places your implants. This is a highly esthetic area and you only get one chance to get this right. A poorly placed implant can cause an esthetic nightmare so ask to see photos of several other cases that they have completed to be sure of the final results. Anyone doing this kind of work should be taking photo's. Be sure that the roots of the adjacent teeth are divergent and not infringing on the implant space. Also be sure that there is adequate bone and soft tissue on the facial aspect of the missing tooth spaces as frequently, missing teeth cause resorption of the bone in this area causing the need for pre-implant grafting. The implant needs pinpoint placement for a good result and without good facial bone, it would need to be placed too far to the tongue side. In my opinion it should be a "bone level" implant and should be placed deep enough so that the restorative dentist can build an emergence from the gum that matches your other teeth. Lastly, it appears that your other anterior teeth are quite flared. Remember, once you place the implants they cannot be moved so if you were ever considering orthodontics, NOW is the time to do it. That would also be an advantage in that your case could be set-up ideally for the implants by the orthodontist with the help of your other team members (general dentist and surgeon/periodontist).
I hope this helps to clarify your situation.
Do your homework!
Although you might clinically be a good candidate for implants to replace your lateral incisors make sure you are under the care of a reputable cosmetic dentist to get a natural looking result. Lateral implants require careful treatment planning and coordination between the surgeon and the restoring dentist. Make sure if two doctors are working on the case together that they have done similar cases in the past and can show you before and after pictures of how it turned out. Your lip line looks to be about even with your gingival margins. How the teeth look after they are finished will be dependent on how the soft tissue or gums are trained and maintained after the implants are placed. How your future implants function in relation to your biting and chewing patterns is also incredibly important as well as your current periodontal health. Again,this is one of the most difficult areas to get esthetically pleasing results and successfully treat. Make sure you find a professional with lots of experience and plenty of cases like yours under their belt. All the best.
Replacing missing lateral incisors with implants
From the look of your photos #7 seems to be less room that #10. A small diameter implant would be best suited for your situation. I would have the surgeon evaluate your radiographs to verify the tooth root position. If the roots converge on each other then there might not be enough room and more orthodontic treatment to upright the teeth might be necessary. I would also have a periodontist evaluate the area. Your smile line is high and I find that in general periodontists are more skilled in handling the gum tissue. That is not to say that an oral surgeon could not do it but my personal choice would be a periodontist. Best of luck.
Small diameter implants with proper gum positioning look beautiful
This will be a wonderful opportunity for you. The new smaller diameter implants now make previously difficult placements now possible. Sounds like you have substantiated that with the two different offices. Cosmetics is the key in this area and placing the implant under the tissue at the proper depth so nothing shows of the implant body and the gums appear healthy and so that the length of the tooth from the gums to the incisal (chewing) edge is correct and that the angulation fits in line with the other teeth are all critical issues. I always use my periodontist for these anterior implant placements because they give me the best tissue health and positions as this is their specialty working with the gums. The gum health and appearance around the implant body are very important to me. Then I as the referring dentist can build the crown on the implant for the "icing on the cake". These can end up looking so real and beautiful even the dentist can not tell the difference.
Can implants beplaced in small spaces?
Thank you for posting photos. YES , you can place implants there BUT here's a few things to consider:
1) Your bite is not ideal. You lack the proper distance and height between in the anterior upper and lower teeth. When you look at your bite in PROFILE your two front top teeth are angled pointing out. SO if your implants are placed In the surgeon has to work very closely with your restorative ( general ) dentist if you like not to address your bite issue, the implants need to be aligned with your existing teeth
2) In anterior ( front) region of your mouth, you can get gum recession after placement of an implant in less than 5 years. implants may show, get closer the gum, and esthetically create an unpleasant look. ANOTHER reason why the implants have to be placed with close cooperation of your dentist and surgeon.
3) Due to issue# 1) teh choice of what type of crown placed in after the implant has to be fully considered
Hope that helped .. good luck ;)
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.