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Center Front Dental Implant -Ramsey Amin DDS

This is a great example of a difficult center front tooth dental implant .  The gum is thin and it is very scalloped.  I restored this case with a cemented  (rather than screw retained) custom zirconia abutment and porcelain crown.  The white zirconia underneath the gum line prevents the gray show through that many front dental implants have. 

The gum sometimes needs to be thickened as well which was done by a simultaneous gum graft at time of extraction along with a bone graft to fill the void between the implant and bone.  I made sure the gum line did not move by shaping and forming the gum to prevent black triangles and a long tooth.

Final photo was taken 3 years after the original just this week.

high scallop, thin tissue
custom cementable zirconia abutment
final crown 3 years after insertion
x-ray taken 3 years after placement-Ramsey Amin DDS

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

10 thoughts on “Center Front Dental Implant -Ramsey Amin DDS

  1. Dear Dr. Amin – I am a 62-year old woman with gum/perio issues and bone loss in some areas of my mouth. I keep regular hygiene appts and keep my teeth as clean as possible, always (no cavities in over 10 years, very few in my lifetime). I had a vertical cracked tooth, upper right bicuspid (? don’t know the tooth #) in 2014, it was removed and replaced with an implant. The implant is short and not useful except as a spacer between the upper teeth. A bridge was not done because of the location. I do not like having the implant. It was frightening to have my jaw drilled into, I thought it might crack during the procedure, and I have to work extra hard to clean around the implant and keep it infection free. I did not know that there is always a gap between the crown and gum. This isn’t the case with bridges, I have one which is pretty easy to clean and has been trouble free. As a result, I do not want another implant (although I am insured). In 2016 I noticed mobility in lower #29 – periodontist had me in 4x yearly for cleaning – I also kept a scrupulous cleaning regimen and the mobility went away. Then the Dr. abruptly retired and I have been without a good periodonist and hygienist for a year. (Just one cleaning in that time) Two weeks ago, both 29 and 30 suddenly became noticeably loose and infected – I went to a regular dentist who prescribed an antibiotic, and was referred to a periodontist who plans to remove these two teeth and wants to put in implants. I explained all of my above concerns to him, but he insists that I should not even consider a denture for those two spaces and would not even discuss it. His treatment plan is that I have the extractions, return later for bone grafting, and in several months, for implants. Question for you: Have you had patients wear dentures during the time they were awaiting implants, and how did that go? I am willing to at least try it. Thank you.

    1. NOT NORMAL = “I did not know that there is always a gap between the crown and gum.”

      something sounds strange with how the tooth was restored. Sounds like you had a different person making the tooth and a different person during the surgery. Depending on their relationship I would suggest you see a third-party and have the area looked at. My guess is that it can be made to have no gap which will then look and feel normal.

      As for the lower arch, replacement with dental implants is the way to go. You can definitely where a small removable denture temporary during the process if the molars cannot be placed at the same time of extraction. Many people do not like this removable temporary denture and end up paying for it only for it to sit in the drawer.

  2. Hi Dr.,
    I had a front tooth extraction #8 on 9/4/18 along with a Bio-Oss bone graft in preparation for a dental implant. My plan is to go back to the surgeon in mid January 2019 to get the implant and have the permanent crown installed by my regular dentist in July 2019. (I’m spreading this out so I can pick up more dental insurance coverage as my dental coverage renews each July. After the tooth extraction, I waited a week and went to my dentist. We decided not to do a flipper because my dentist made a partial retainer for the top six front teeth and fashioned a tooth inside with bonding material. He curved it so it would make an oval shape in my gumline. I’ve been wearing the retainer for approx 4 weeks now and have noticed a high spot in the middle of the gumline which now make the gumline uneven (higher) when compared to the other front tooth.. My concern is this high spot might be seen when the abutment is attached to the permanent crown and my gumline will be higher and the metal abutment might even show. Is there anything I should do at this point. Should I go back to the surgeon or dentist to have them re-evaluate my gum and/or do a flipper instead? I’ve also heard that soft tissue grafts can be done to change the shape of a gumline. Please let me know what will be the best fix for this issue as I want to be pro-active at this point.
    Thanking you for your response,
    Judy
    P.S. You have a great website loaded with lots of information. Thanks!!!

  3. I just got an implant on my front tooth and a gum graph and a bone graph. I can’t wear my flipper anymore because my gums are swollen and the implants there so it’s hanging too low and my flipper won’t fit. I’m sure u can imagine what I’m talking about. I had an Essix made but it looks absolutely horrendous. What are my options? I’m going to university in one month and I just want to look normal please help me

  4. I am 10 days post front tooth implant with bone graft and temp put in place, and I am suddenly feeling an increase in pulsating and tingling today, I don’t know if I bumped it in my sleep or something, is there anything that the dentist can give me to brace my back teeth together so I don’t accidentally push on my front tooth? If I did push on it will it need to be redone completely? Could it be a sign of infection? The Zpac should just be going out of my system.

  5. Dear Dr. Amin,

    I’m writing you on behalf of my mother actually. She had an implant on one of her incisors approx 10 yrs ago I believe and lately it has become loose and she has some signs of infection. She had an xray in early July and exam. She was told she would need a ‘new’ implant and bone graph. She is able to wiggle tooth on her own but it won’t simply ‘pull out’..but its loose. She sent me a picture of Xray and I didn’t notice bone loss really (perhaps not seen in that one view angle) Anyway, you mention on your blog that sometimes a bone graph can be done while leaving tooth and achor etc ‘in place’ I think you said ‘back’ teeth easier as they are thicker etc. My mom is healthy and slim & no meds I believe. she is over 70. I’m trying to help her make the right decision by researching.
    Is it most likely that her tooth ‘failed’ after 10 yrs because of infection that ‘then’ caused bone to soften? She says she is pretty good about brushing her teeth and flossing. Is it possible to graph bone to front incisor while implant stays in? I would sure hate for her to have to go through a complete removal..3 months healing…then graph 6-9 months..then essentially a ‘new’ implant from scratch. *she may have another xray (different angle) scheduled soon…as she didn’t want too many xrays all at once..I think she said. I sincerely appreciate your time, advice and opinion.

    Michael Roberts
    Hayward, CA

    1. Thank you for your comments Michael. If implant is loose it cannot be rescued or recovered. The best course of action is to remove and replace. The condition is called peri-implantitis and is most likely what your mom has. Dental implants are not forever neither are crowns are fillings. that is a bunch of marketing garbage. I typically consider success to be 20-25 years so perhaps 10 years is premature but this can also be a bite issue as well without seeing her I cannot give you exact guidance except that staging the procedure as you have described is likely the best option. she must have a complete set of back teeth for the bite to be a nonissue. If she is missing back teeth are wears the partial the front implants are often overloaded.

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About Ramsey A. 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.