Case Presentation: Esthetic Implant Placement and Tissue Sculpting

Esthetic Implant Placement - 2Meet our patient “JB” who presented to our office with a missing central incisor #9. JB is  39 year old female with controlled type 2 diabetes and borderline hypertension. Her chief concern was “I am embarrassed to smile, can you fill the gap? I want an implant, will it look natural? I also want to go to sleep for it, can you do that?”. Under IV sedation, Dr. Anderson placed JB’s implant and began the tissue sculpting process with a temporary crown to not only allow for a permanent tooth to fill the space but to shape the gingiva or “gum” around the implant.  JB reports that her implant with Dr. Anderson was “pain free” and she now is more confident with her new smile.  See above for JB’s evolution through care with Dr. Anderson.

Key: (a) initial presentation with missing #9  (b) custom temporary crown used to mold the gingiva or “gum” (c) temporary crown insertion (d) soft tissue sculpting or “papilla formation” (e) occlusal view showing triangular shape in cross section mid-root (f) “gingival scallop” creation as seen from the buccal or “front” (g) final distal view (left lateral) (h) final mesial view  (right lateral).

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What Is Implant Disease?

Implant Disease Treatment Before and After

Above two patients presenting to Dr. Anderson’s office for the initial implant disease evaluation.  On the left, a moderate case of mucositis (#9) and on the right a severe case of peri-implantitis (#’s 4, 6, 9).

Although uncommon, dental implants can develop infections just like natural teeth. This infection can involve only the gingiva (gum) as with “mucositis” or extend to the bone as with “peri-implantitis”. As with natural teeth, implants can be lost due to advanced stages of the infection and may require replacement.  Luckily, periodontal treatment is predictable and effective in the treatment of mucosistis and peri-implantitis. Periodontal researchers are now developing more sophisticated techniques that aim to restore the original condition of the implant. To learn more ask your periodontist!

How do I know if I have peri-implantitis?

There are several techniques a periodontist uses to determine if your implant is infected. He or she will look at radiographic bone loss, probing depths (check the gum pocket), bleeding, suppuration (pus) and mobility.  Unfortunately, many  patients do not experience signs or symptoms until the disease is advanced.  Early diagnosis and treatment are paramount to maintain the implant in the best function and esthetic as possible. Contact your periodontist if you have an implant you suspect may be infected for the proper work-up and treatment if needed!

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Is An Implant Right For Me?

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Dental implants are permanent tooth replacement options for patients missing one, some or all of their teeth.  Dental implants were introduced in the 1980’s as an evolution from orthopedic use in joint surgery.  Today, they are the #1 option for tooth replacement due to the success rate and predictability of reaching proper function and esthetics compared to natural tooth bridge and denture options.  Implants provide advantages over these other options.  Implants preserve adjacent tooth structure, underlying bone, and proper biomechanics of the bite. They are permanent, do not require removal, and are more esthetic.  According to systematic reviews, success rates of implants over the lifetime average in the mid to high ninetieth percentile whereas the five year success rate of bridges are in the seventieth percentile.

Dental implants are composed of three parts. The implant itself is a titanium alloy screw that is placed into the jaw by a surgeon.  After healing, the implant crown is screwed or cemented into the implant via an abutment by the general dentist.  Implants are taken care just like natural teeth and require normal brushing and flossing.  Just like tooth crowns, the implant crowns are made to fit with individualized color and contour. They function and appear like natural teeth and if taken care of properly, implants can be kept for a lifetime in healthy individuals.  Ask your periodontist if you are a candidate for implants and if they are right for you!

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