I recently had my old crowns removed and I will need to get an implant. The cosmetic dentist made temporaries which still have an 'overjet' that I had from previous crowns. (He took an impression of old crowns for temps). I will be getting an implant and I'm worried about the position that it will be inserted. When I smile and slightly tilt my head back you can see inside my mouth. When I asked the dentist he told me that the lab will be able to adjust the crown to an ideal position. I'm worried.
Questions About Dental Implant Placement?
Doctor Answers (5)
Pre-treatment diagnostics before implant placement
Your fears and concerns are absolutely valid. The proper sequence of comprehensive treatment of aesthetic areas will start with complete diagnostic step- wax-up models that will emphasize the new improved bite with all corrected problems. Based on this wax-up model (that the patient should approve) the new provisional crowns should be made, and get the patients` approval. Otherwise, the wax model and provisionals should be corrected. The best option for you will be to get a second opinion from a prosthodontist, specializing on full mouth reconstruction cases.
Your concerns are valid regarding position of implant.
When re-doing crowns whether on teeth or implants, you and the dentist need to decide if you will change the shape, possition, and color with the new crowns. If the answer is no, then you can just use an impression of the old ones to make the temps and the finals. If the answer is yes, then you still take an impression of the old crowns but you then modify as needed on the cast model (this is called a diagnostic wax-up) and use this as a guide for the temps and new crowns.
You can also use this wax-up to make a surgical guide for the surgeon to place the implant in the correct possition. There is some room for error with this, since slight discrepancies can be corrected with the abutment and porcelain. However in the front teeth, the implant surgeon has to be very detail oriented in the placement because once it is placed it cannot be moved. If the implant is placed too shallow or too much to the front, it could really compromise the looks, so it is better to err on the deeper or more palatal side, but only to a certain point.
Basically the surgeon reallly needs to know what he/she is doing and needs to have good knowledge of the final position of the teeth and gums. Many surgeons are soo good that they get great results without the use of a surgical guide but it can only help to have one made.
One last thing: I do not completely agree that the implant possition is dependent on the bone available. Now a days, surgeons can bone-graft many areas as needed so that the implant can be placed in the most ideal possition and not end up with a compromised esthetic result.
Dental Implant Placement
A true "cosmetic dentist" would have his lab make an ideal wax-up of how he wants the permanent caps to be located, and make the temporaries based on that wax-up, NOT based on your original overjet. That way, you and he would have a chance to evaluate the "new look" and function BEFORE having the permanent caps made.
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Dental Implant Placement
Implant placement usually depends on available bone. The surgeon who places the implant should use a guide to alleviate some of your concerns. The lab also plays a role in the process and they will help make your crown look more natural
Implants require bone
Quite often, implant placement is where it has to go based on available bone and bite forces. Usually in the front, the implant must be placed more towards the roof of the mouth, more so than the original tooth. The lab DOES then contour the crown to look natural. Odds are you will be just fine.