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Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting

This is a dental implant immediate tooth replacement case that I did in my Burbank office a few days ago. There are many details that make this dental implant unique. He only lost this tooth about six months ago, and the bone had already shrank, causing an indentation defect on the critical outer wall of the bone.

A bone widening expansion graft was done at the same time the implant was placed, and a temporary was made on a prefabricated (not custom) dental implant zirconia abutment.

Notice the pre-operative picture with the bone void. If nothing is done to correct this, the tooth will look funny. It will be long, and may have black triangle holes on each side. Being from Los Angeles and being in sales, this would not be an acceptable appearance.

For this bone graft implant procedure, I flapped open the gum just enough to see the edge, and actually bent his bone using a “D-shaped” device called an osteotome. He elected to have the procedure while he slept under IV sedation in my office in Burbank.

A 3.7 x 13mm internal hex dental implant was placed as the final expander and the semi custom zirconia abutment was torqued into place. I stitched the gums on either side of the zirconica dental implant abutment, and made a temporary that cemented to the implant.

You can see that the bone widened significantly, and is now even with the other tooth. These pictures are taken on the day of the surgery!

What makes his situation even more tricky is his overbite. This tiny detail can cause an early failure where the implant would loosen. On immediate dental implants, the temporary must be made to not touch the opposing tooth. You have to stay off of the temporary dental implant tooth for about 2-4 months, on average, for the implant to heal. After it heals, the final all-porcelain lithium disilicate crown will be made.

I will follow up on this case in the future so you can see the final result. He was thrilled not to have to wear the temporary denture anymore, as he is only about 40 years old!

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

6 thoughts on “Burbank Implant Dentist Explains: Immediate Front Tooth Replacement with Bone Expansion Grafting

  1. I need #9 extracted due to the fact it is dead and there is an off and on pus pocket. Do you believe Dr. Amin, that it is better to have the extraction and grafts on the same day or to have the tooth extracted and then go to my dentist for ozone treatment and within less than two weeks have the membrane. bone graft and titanium implant done and then wait until I am ready for a crown? Thank you. My daughter lives near Burbank and I think you are awesome. Toni

    1. Thank you for your kind words. Tooth #9 is the front and center incisor… It is critical that the diagnosis and treatment plan is done correctly to avoid problems and to have a great outcome. The goal is always to have the extraction and implant the same time if possible. This preserves the gum architecture and maintains the good looks of your tooth. This is not always possible but is definitely the goal. I would suggest you find a highly skilled provider to do this for you. Ozone is not necessary

  2. I am considering implant for missing #8 & 9. They have been lost for over 10yrs. Denture was the replacement.

    1. Do you think that it is highly likely that bone growth will be needed before any implant?

    2. If the bone growth process is required first, will I have go without a denture for a while? This is a concern because I have to work in the public.

    3. If the bone is in a good condition is it possible to do a same day implant or you would not recommend a same day procedure.

    Thank you much.

    1. Hi Dave,

      After missing your teeth for that long it is likely that you will need a bone graft. The front center upper teeth are critical to your appearance and generally has aggressive bone loss. Ask your dentist to make you an Essix temp bridge so that you can have teeth during the process.

  3. This is WOW !
    I am 26 years old and I’ve lost my two central upper front teeth, 4 years ago and I’ve replaced them with a bridge but it doesn’t really look nice as it was made of metal, now i am on a stage of replacing this bridge with another one made of zirconium !!
    to be honest, i don’t want any bridges in my mouth and what I’ve been asking for – for very long time- is whether i can put two implants instead of a bridge?
    My dentist said that putting an implant will need a lot of work and it won’t look that natural considering the gum, the bone and all. soooo??

    1. Hi Houda,

      You may want to have a second opinion ONLY if your dentist is not heavily experienced in dental implant tooth replacement.
      What is his experience?


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

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About Ramsey Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.