Implant not aligned with teeth? (Photos)

I needed the implant on my left lateral incisor, I also had a baby tooth as my right which needed a crown. I got both done in same appointment. When he was finished I was happy but it wasn't until further examination when I left that i noticed the two teeth do not match or are aligned at the gum with the rest of my teeth. I have a followup appointment next week should I mention it, can anything be done to fix it? Is this just the way my gum line falls or is this a mistake on his part? Thanks

Doctor Answers 4

Implant, crowns and gumline

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It is hard to give a complete answer without X-rays and pre operative photographs of your case. With that being said, there are some procedures that may be employed to possibly treat your situation. You could have gum surgery on the left lateral incisor and canine to raise the gum. If the implant on the upper right lateral incisor has a ridge lap, the porcelain in the ridge lap area could be trimmed down. However, without knowing exactly what you have and not being able to perform an exam, this is all speculation. You need to bring it up with the dentist and see if he has the ability to treat this. If not, you'll need to see an experienced cosmetic dentist and a periodontist.

It looks like your implant is actually on the right lateral incisor and the peg lateral was on your left lateral incisor. Is your photograph reversed in the submission? If it's the way you say, then I may answer this question differently. But the pictures look to be in reverse of what you described.

Douglas Jopling,  DDS
Dallas,  Texas area

Implant positioning

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The end result of the crown is usually more a function of the implant placement than the crown itself. It's probably wise to speak with both the restoring dentist and the surgeon about this. 

Sue Wendling, DMD
Portland Dentist

The gumline matters more than most people think!

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The quick answer to your question is that you could mention it, and yes, something can be done to fix it. However, it will probably require additional surgery as well as finding another dentist that understands the complexity of cosmetic implant dentistry. Without seeing preoperative photos it is hard to say, but likely that your gum tissue is naturally in that position.  Clinically, it is not easy to know from a photo, but from what I can see, it is dentistry done to the standard of care when it comes to function.  Continue reading if you want a clearer picture of what my take on your situation is...

What happened to you is a classic example of poor communication between the doctor and their patient, as well as the ever growing gap between dentists with particular skill sets.  What I mean is that a dentist is not a dentist is not a dentist.  30 years ago most dentists practiced on the same playing field and had similar skill sets.  Today, technology and advances in dental education, and the way we practice dentistry has created niches within dentistry that most lay people do not understand.  Please do not take this the wrong way, I am not placing any blame on you for the esthetic outcome of your case.  It is, in my opinion, the dentists job to clearly define and explain expectations to patients in terms of outcomes of their treatments.  Your picture shows what looks like a very functional and probably quality restoration on both sides.  However, the esthetics or cosmetic component is partially missing.  Color, size, shape, position of gums, and certain other characteristics must be taken into consideration by a dentist attempting to achieve the most natural result.  If this is not possible, which is entirely plausible in your case, the dentist should let you know that there may be some compromising with a certain procedure.  Or, develop other options to reduce the chance of these things from happening. 
I don't think your dentist did a terrible job of getting teeth back in those areas for you.  However, he or she completely missed the boat if they did not discuss with you outcome expectations and or discuss the esthetics component of this type of procedure. 

I am sorry that you are not satisfied with how the procedure turned out, and I hope you are able to find a dentist in your area that can help you mend the issue.  If it is any consolation, I have seen much worse esthetic and functional outcomes with this type of procedure.

Warm Regards,

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Implant crowns can match real teeth

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The biggest challenge we implant dentists face is having enough gums so the implant crown doesn't look longer than all of the remaining teeth, but the opposite seems true here. If the implant was placed "subcrestal" (below the bone), and the bone height on that side is equal to the bone height on the other side lateral, a dentist can sculpt the gum tissue above the implant (with a laser if possible) to have the gums match on both sides. Then, a new crown can be made to better match the proportions of your other tooth. If the implant was not placed low enough to achieve this look, you may not have an easy solution with this implant. Definitely discuss this with your restoring dentist. Good luck!

Andrea Stevens, DMD
Ottawa Dentist

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.