My Dental Implants Sit Higher Than My Natural Teeth. My Dentist Doesn't Seem Too Worried? (photo)

Question

My dental implants wihcih consists of 4 teeth bridge (2 implants) is ugly as is sits higher than my natural teeth..and YES I had bone grafting, paid extra for that of course. My smile is terrible now my front teeth sit normal and then you see these huge fake teeth with the high arch..it has been over a year and although I told my dentist I wasn't pleased with the aesthetics and ONLY the funtion he really didn't say much?? what are my options without another high cost?? :-( I'm very sad*

Mauricio C. Tijerino, DMD · Answer

I'm afraid once your implants are placed there are few options. Your case  needs very carefull and thought out treatment planning due to the fact that you show all your gums when you smile. What did you have before the implant bridge? Where you happy with the way it looked before?

	The teeth look fake and big because they are to high on your gums. Specially the left lateral incisor.  This could be due to improper implant placement or improper planning prior to implant placement. Many times you can set up the case by using braces and or grafting to bring down the gum and bone. This way you avoid having this "high tooth" look. If you were already missing teeth, then it may be very difficult and making a conventional bridge without implants may give you a better outcome. Also, the implants could have been placed in different sites to take advantage of better bone or gums in the area.

	At this point there are very limited things you can do to fix this without any major additional work. The bridge would have to come off and a temporary one placed. We can play around with changing contours and see. You may end up needing a Connective Tissue Graft and or re-placing the implant in a lower or different possition. Your dentist is indifferent about it because he knows this is not easily fixed, but if you are not happy, you should see 2nd or 3rd opinions. However, it will be additional cost. However, this can be improved. 

	 

	Good luck

	Dr. T

Raj Kumar, BDS, LDSRCS · Answer

I am very sorry that you are not happy with the gum around the implant crowns.

	This is a case of having been warned that this might happen.

	Once teeth are lost, the bone and gum shrinks and it is very difficult to replace those tissues except in skilled hands.

	The high gum line will naturally amplify the problem.

	To correct this is very difficult as the bone architecture supports the gum and the gum lline.

	I have 2 suggestions that you may consider:

	1 soft tissue graft under the gum by a specialist

	2 replace crowns/bridge with new ones with the gum area masked in pink gum coloured porcelain again by a reputable ceramist

	Redoing bone grafting would mean taking out implants.

Zev Kaufman, DDS · Answer

I am sorry to hear about your situation. However, the problem here is of miscommunication. Once teeth are lost, invariably, we see resorption of the alveolar ridge, the bone the teeth rest in. Even with extensive grafting, it is difficult if not impossible, to fully regenerate that ridge. In addition, the expensive grafting procedures, do undergo resorption overtime. When the smile line is low enough, it is usually not a problem. It is of course better to inform the patient prior to any work, and a competent specialist would normally do just that. In your situation, the very high smile line, creates a challenge, and even with informed consent, the results end up looking like yours-- somewhat compromised. I suggest that at this time you make an appointment with a prosthodontist in your area and go hear what the specialist in this area has to say. Search the Internet for locating a prosthodontist near you. Best of luck, Dr. Zev Kaufman

Brian Dorfman, MD, DMD · Answer

Your photos are a little blurry, but I can see your concern.  You have a very high smile line and show a bit of gingiva with your normal smile , abut the teeth on your left side seem longer than your right side.  ( I am guessing that is what you are trying to get across).  I am not sure what type of bone grafting was performed.  I am also not sure of the type of surgical specialist that treated you either.  In retrospect one of the first considerations for your treatment shouldhave been your high smile line.  the bone grafting technique the increasealveolar bone height in the area and most likely soft tissue grafting or advancement flaps should have been taken into consideration.  Prior to the implant placement, photos and wax ups should have been evaluated to make sure there was symmetry from right to left (or at least as close as possible). If there was not enough gingiva showing on the left during smile, more tissue grafting could have easily beeen done to increase the amount of gum tissue showing at smile, which would in turn make it possible for shorter teeth to match the left side.  This can still be accomplshed with some soft tissue grafting to bulk the area up possible, but you would need a new bridge and be placed in a provisional bridge during the healing to make sure you are happy with the final results.  I know this is a lot, but think about it and best of luck

Gary Nack, DDS (retired) · Answer

Unfortunately it is very hard to determine exactly what is going on with your case as your pictures are too blurry to see.  It appears that your left lateral incisor has a longer crown and that the gum is more recessed in that area.  This may be due to overcontouring of the implant abutment as it emerges from the implant and through the gum.  If the gum was level with the adjacent teeth before restoration of the implant and now appears recessed, that is most probably the issue.  Your dentist can try removing the crown and abutment, placing an undercontoured provisional restoration and allowing the soft tissue to rebound back to its original position before remaking the final restoration again. Other potential issues are poor implant angulation or placement which will require more complicated resolutions.  My best advice would be to visit a restorative dentist that is very experienced in implant dentistry to discuss your issues. Remember, implant dentistry in the esthetic zone is complicated and must be planned carefully by both the surgeon and restorative dentist for a great result. 

	Best of Luck!

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My Dental Implants Sit Higher Than My Natural Teeth. My Dentist Doesn't Seem Too Worried? (photo)

Answers (5)

Answer: Poor Esthetic Outcome From Dental Implant Restoration IS Frustrating

Answer: Poor Esthetic Outcome From Dental Implant Restoration IS Frustrating

Answer: Unhappy with outcome

Answer: Unhappy with outcome

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Recommended reading

Everything you need to know about Dental Implants

Our mission is to create a world where every investment in modern beauty is Worth It.