This young man came to me with the desire to restore his teeth to function since the implant was failing. While he knew something had to be done functionally, he also desired a different esthetic outcome if possible. When I saw his case, I was struck by the size of the bone and tissue defect that was already present with a failing implant in place. The first step was to do a smile analysis.It may seem contrary to look at esthetics before function, but we always need to know what our esthetic goal is, so we can try to engineer everything to make it happen. From there, the esthetic goal is communicated to the surgeon to try to achieve correct implant placement to make the esthetics of that implant possible. In this patient’s case, a bone and tissue graft were done after the implant was removed. After several months, the new implant was placed. Again, we had to wait a few more months to allow osseous integration to see how much bone and tissue graft would resorb or be lost. Although the grafting helped make a new implant possible, the tissue was still severely deficient, and we were faced with managing difficult tissue esthetics. The patient's gingival architecture was completely flat with no hope of establishing a nice scallop at the same tissue height of adjacent teeth. This patient also had a very high lip dynamic — an all-around high-risk esthetic case!
Author bioDr. Amanda Seay is the owner and solo practitioner of Park West Dentistry, a private practice in Mount Pleasant, SC. A graduate of New York University College of Dentistry and both the Kois Center and The Pankey Institute, Dr. Seay commits herself to hundreds of hours of continuing education each year. In addition to operating a thriving full-time dental practice, she is the CEO of a family of six, including four children under the age of 7.
