Dental Implant is Too Deep, Tooth Looks Long

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.
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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.

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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.

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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.

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Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


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19 thoughts on “Dental Implant is Too Deep, Tooth Looks Long

  1. kay

    Hello,

    I am 38 years old.

    I have 2 implants placed in 2010 as well as the bone graft on #9,#10 . Overtime, the gum receded tremendously especially on #10 and was looking like this patient of yours or worse.

    My current Dr. told me that implants were placed in too deep. so he decided to put #10 to sleep and currently using 1 implant on #9.

    CT scan and x-tray shows that I have enough bone to support both implants and totally functional.

    I have had gum graft in July 2016, the #10 somewhat looked better but #9 started to get worse and the gum is receding now(very long tooth). he wanted to perform another gum graft from the roots and tries to pull the gum down but I wanted to wait on it and place a final crown for now, because I am hoping to move to CA in few years and I feel likeI need a experienced doctor.

    I am a very thin person and my gum also is very thin….the Dr could not take any from donor site so he used an alloderm.

    But as I was reading your comment here, it is better to stay on the temporary crown rather than final if I want to pursue more surgery in the future???? I do not want to give up yet although I have very complicated situation(high smile line) and result may be compromised, I still want to improve esthetics a little more than right now.

    The Dr doesnt want me to stay in the temporary since I am hard grinder at night(using mouth guard )and hard biter, my temporary fractured twice and the screw got loose multiple times so that I got accesses etc…(but implants looked good on x-tray).

    I have planned to start making the final on 1/23/17 and I am wondering what are your thoughts on placing the final now?

    and about my over all situation. is there any treatment options left for me?pink porcelain is definitely my last resort……

    Reply
  2. Kay

    Hello,

    I am 38 years old.

    I have 2 implants placed in 2010 as well as the bone graft on #9,#10 . Overtime, the gum receded tremendously especially on #10 and was looking like this patient of yours or worse.

    My current Dr. told me that implants were placed in too deep. so he decided to put #10 to sleep and currently using 1 implant on #9.

    CT scan and x-tray shows that I have enough bone to support both implants and totally functional.

    I have had gum graft in July 2016, the #10 somewhat looked better but #9 started to get worse and the gum is receding now(very long tooth). he wanted to perform another gum graft from the roots and tries to pull the gum down but I wanted to wait on it and place a final crown for now, because I am hoping to move to CA in few years and I feel likeI need a experienced doctor.

    I am a very thin person and my gum also is very thin….the Dr could not take any from donor site so he used an alloderm.

    But as I was reading your comment here, it is better to stay on the temporary crown rather than final if I want to pursue more surgery in the future???? I do not want to give up yet although I have very complicated situation and result may be compromised, I still want to improve esthetics a little more than right now.

    The Dr doesnt want me to stay in the temporary since I am hard grinder at night(using mouth guard )and hard biter, my temporary fractured twice and the screw got loose multiple times so that I got accesses etc…(but implants looked good on x-tray).

    I have planned to start making the final on 1/23/17 and I am wondering what are your thoughts on placing the final now?

    and about my over all situation. pink porcelain is definitely my last resort……

    Reply
    1. RamseyAminDDS Post author

      I would stay in a temporary for longer. you may want to consider removing the implant altogether and just starting over. This article on formation of the triangle of gum tissue may help you get a better understanding for how I use temporary restorations to achieve ideal aesthetics. Keep in mind this always starts with a well placed implant with at least a millimeter or 2 of bone on the outer surface. Good luck, I hope everything works out for you.

      Reply
      1. Kay

        Thank you very much for your response.

        I saw this article, looks amazing. and I definitely believe that I need to remove these implants and do all over again. but I want to do it when I move to CA.

        I still have to stay where I am for an another few years.

        May I ask the reason why I should stay in temporary? I did not see you mentioning about it in the article or the comments.

        I do know it hurts financially to make multiple finals but my root of the temporary got broken and loose multiple times because of my hard bite and grinding.

        Even then, would you recommend to stay with temporary???

        Reply
        1. RamseyAminDDS Post author

          yes, the temporary needs to be made so that you cannot bite on it or grind on. It should be completely out of the way of all of your teeth. I have many patients that stay in temporaries for a year with no issues.

          Reply
  3. Michelle

    Do you have any contacts that you would trust with this procedure in the Netherlands ( I am currently working here) or Northeast (US – I will repatriate to Boston when my assignment is done).

    Reply
  4. john

    thank you for the very well written explanation…my friend went to a really cheap dentist and ended up looking this way. It was one of those billboard/radio advertisers. I need an implant too…I will be calling your office.

    Reply
    1. Ramsey Amin DDS

      Thanks for your vote of confidence…I will take great care of you. Sorry to hear about your friend.
      here are some examples of patients treated by me:

      Smile Gallery

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, CA

      Reply
  5. Jean

    Hello,
    I just had an implant, crown placement within the last 4 weeks, on my front tooth and have similar results, the gum is 1/2 inch higher on my implant tooth than my other front tooth. I am worried sick about it. My Dr. wants to “wait and see” he said gum grafting wont work and that “nothing is perfect in life”. Meanwhile I shy away from talking to people and I cover my face when I talk. I’m panicked that this is how I’ll have to live now. Do you think it’s too late? Can anything be done? Thanks for any suggestions.

    Reply
    1. Ramsey Amin DDS

      Hi Jean,

      If it is the final crown rather than a temporary crown, your gum is not likely to come down and cover it. 🙁
      Typically on a complex single front tooth I will try to work out all of the aesthetics and gum positioning in the temporary phase. As long as the teeth on either side is healthy and the implant is positioned with substantial bone on the outer wall, the dental implant can be made to look extremely natural.

      It may not be too late to try other options such as removing the crown and placing a temporary but I am assuming you already went through all that stage.

      Some situations no matter what you do are compromised from the beginning and the dental implant will look longer than the other teeth. I have many patients like him to me in the same situation The point is to predict this in advance so that there are no surprises in the end. This is something I spend a ton of time on with each patient so they can understand their final result before anything is ever begun. I know hindsight is 20/20 and doesn’t help too much.

      Let the tooth stay the way it is until about 8-12 weeks after it was placed. That will likely be the final resting place of the gum tissue. At that point you can make some determination with what you want to do.

      Front Teeth Dental Implant Samples

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      Reply
  6. Raymond

    A fantastic article, showing me the benefits of implants and the reality of implants. It exactly tells me the procedure of impalnts. very beneficial read.

    Thank You

    Reply
  7. jojo

    Hi, is what you did here called an autogenous bone graft? then a gum tissue graft? I’m 57 yrs old, and in need of implants over teeth 7, 8, 9 and 10. the cuspids are ok, but also shave a good deal of gum loss. The teeth are still in with the exception of 10 right now, but tooth 9 looks exactly like your patient above, the gum height is dramatically different between 8 & 9. I’m afraid the oral surgeon just wants to put the implants in, and move on. He says when the teeth are extracted and bone is added there won’t be enough bone to support a tissue graft. I’ve been to an oral surgeon and a periodontist, the oral surgeon says the teeth will have to be made larger, and the periodontist says i could get a prosthetic built on the implant crown bridge.
    I’ve told both that I’d like to have gum grafting done, and am willing to get the additional bone but i don’t know why (i’m am in good health) they don’t seem to want to do this.
    Do you see a reason why what you did to the above patient wouldn’t work for me to even out the span in my front teeth? I don’t smoke, have good oral routine, and I’m an easy patient. Thank you so much,

    Reply
    1. Ramsey Amin DDS

      Hi jojo,

      I don’t really know why a tissue graft would not be done. Without seeing you it is very difficult to know your exact situation though.

      If the Implant is already done and the crown is on, a tissue gum graft is not going to cover over the crown on the dental implant.

      Some situations with dental implants are unrecoverable.

      Sometimes you have to extract all the implants and start all over.

      This is why excellent pre-planning and very good execution of dental implants is so important.

      Dental implants are body parts so I suggest you seek out the best person possible. It sounds like you have a very complex situation.

      Dr. Amin

      Reply
  8. Meera

    Hi Dr. Ramsey.

    I had two teeth removed. Reason: infected. Broken. Bone was gone.

    My dr did “bone grafting” for him to be able to place the implants. He closed it to heel for 6/7 months. He then applied the implants.

    The implants are next to each other. They are both long. Very white. Exactly like the patient in this picture (not front teeth though, back.)

    Even though he did bone grafting. I feel that it was completely medical. And not cosmetic at all. I lost width in this area. My bone was wider. And nicer looking.

    Now when I smile. You can see long white ugly teeth. Not in rhythm with the rest of my teeth. And darkness on top of these two teeth. Due to lack of “width of bone” in this area.

    My concern is can all the width be restored? Even length of gum? And what should I say to my doctor?

    If I need to change my dentist. What specialty should I be looking for in a dentist? Is there a specific type of dentist that could fix my smile?

    Thank you,
    Meera

    Reply
    1. Meera

      To be more clear. The two teeth that where amputated and replaced by implants are (First molar and second premolar)

      Reply
    2. Ramsey Amin DDS

      Hi Meera,

      You likely have loss of vertical bone rather than width. As soon as the bad teeth were extracted the underlying bone loss that was hidden by your gums became much more apparent. The bone graft was likely only done to preserve what you had but not to build back to its original height.

      Once the implants are in, there is not many good options except for removing them and starting all over

      sorry for the bad news.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply