Esthetic Compromises in the anterior around implants are unfortunately more common than we would all like. Many of these issues can be avoided with proper treatment planning and the incorporation of ancillary procedures that set the anatomy up for a more favorable outcome. When this doesn’t happen and you get an unintended negative consequence, trying to correct the situation is often more difficult than the original treatment plan. This is the exact situation I was presented with recently.
Young, female patient with a high smile line. She lost her upper lateral incisor following failed endo and post core. She presents after having had multiple opinions from surgeons and restorative dentists alike. Her chief complaint is the discolored area at the edge of the crown and the dark grey color of her gum tissue. She guards her smile, but typically has 4-5mm of gingival display over the implant. The rest of her mouth is healthy.
- No Periodontal pockets or inflammation
- No Caries
- One lower molar with a marginal ridge fracture requiring a crown.
- The fixture is well integrated
- No Medical Concerns
- Joints WNL’s
- Muscles WNL’s
- Occlusion WNL’s
So what are the possible solutions? I say possible because I believe in dentistry there is always one diagnosis, but multiple appropriate treatment plans depending on the patient’s desires.
Aly Sergie DDS says
Diagnosis – fenestration or dehiscence of buccal bone so that the metal of the implant is showing.
Treatment options – whatever that can be done to thicken the tissue or graft over the fenestration. From your photos, this does not look like a prosthetic issue.
Aly Sergie DDS
Did the implant surgeon graft before hand?
I agree with Aly that the bone is insufficient buccal to the implant.