Whether it is from trauma, infection or congenital reason, when front teeth are missing or non restorable, unlike any other area, there is a strong desire for the patient to replace them. And many times, the most suitable treatment option often involves the use of dental implants.
To me, delivering a predictable and esthetic dental implant restoration is very gratifying. However, I have to respect biology and know what I can and cannot do. One must understand the ideal implant placement in three dimensional space: gingival occlusally, mesial distally and buccaly lingually. The margin of error is such that even if it’s off by 1mm, it can have a compromised prosthetic outcome.
Communicating Gingival Esthetics and Managing Expectation
When I am doing an implant case for the anterior region, I make a point of reviewing the ideal gingival esthetics versus what the expected achievable gingival esthetics will be, based on the patient’s existing gingival biotype, volume of bone and the patient’s smile line.
Sometimes it is really hard to tell a patient what a missing papilla would look like. But pictures are worth a thousand words. Prior to the start of treatment, I often rely on pictures to illustrate what I mean by a missing gingival papilla. This is important to me so I can manage their expectation of what is biologically feasible before treatment begins.
My standard treatment protocol also includes a set of temporary implant crowns to illustrate what the gingival portion of their implant crowns would look like.
That way, the patient’s expectation will be more consistent with what I can deliver and the outcome will be much more controlled and favourable.
Delivery implant restorations in the esthetic region is all about managing my patients’ expectation. Knowing what is possible and the limitation ahead of time will allow me to pave the way for what my patients can expect. And when the final restoration is delivered, there would be no surprises for both the patient and the doctor.
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