Dental implants, especially in the front of the mouth, need to be placed with a high degree of accuracy. When an implant is placed too shallow or worse yet too deep in the front of the mouth it creates a cosmetic failure– a long tooth and sometimes black triangles.
This is especially true on a patient who has what we call a “high smile line“. This is when you smile and you show more of your gums than average. If she had a low smile line, then it wouldn’t be noticeable when she smiles.
Here is an example of a patient that had an implant placed in about the year 2004. The dental implant was placed as an immediate tooth replacement which is a great option most of the time. Unfortunately the dental implant was placed too deeply into the bone. She hated this tooth.
When this happens you end up with a very long tooth. And worse yet, there is not a lot of good options that can be done to correct it once it is in this position. So in her case, I had to actually extract the implant and rebuild her jaw bone with 2 to 3 bone grafting and gum grafting procedures in order to put a new implant in a more shallow position. A block bone graft was needed also.
This is about as difficult as it gets. This case is difficult because I had to regrow bone vertically, closer to the edge of the natural teeth. Building bone vertically rather than horizontally is always more tricky and requires several very advanced techniques.
You can see in the picture with the white dental implant custom abutment, that the new implant is at a better level because the gumline is more even with the tooth next to it.
Unfortunately the deeply placed implant permanently stripped bone off of the teeth on the side, and that is not repairable.
Compare the levels of the two implants on the x-rays. One is much more shallow than the other. The shallow one was placed by myself and the deeper one was placed back in 2004 by another dentist.
Occasionally you can recover a deep, long tooth implant with a new custom abutment and gum graft. But I caution you that this is truly a very difficult procedure and should be completed by an expert in implant dentistry so that you can anticipate a result before you ever even get started.
Please feel free to ask questions or leave comments below.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry