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Lower Front Tooth Dental Implant –Immediate Tooth Replacement

Lower front teeth can be complex implants.  Many dentists only focus on the upper front implants and there is not much talked about lower incisor immediate implants.  They are usually complicated because the space is very tight.  Natural lower teeth are very skinny and oftentimes people have crowding and or periodontal gum disease of these lower incisors.  If they are just the tiniest bit crowded they become almost impossible to place an implant without getting too close or touching one of the adjacent roots.

Most implants for the lower incisor are in the range of 2.5-3.2 mm.  I would not advise mini dental implants for these areas as they are weak and can bend and break off.  They are consider temporary implants

In this case I was able to remove a single broken root canal lower front tooth incisor.  On the same day, I placed an immediate dental implant into the socket with a small bone graft to fill in the void between the implant and the existing socket bone wall.

broken lower front tooth
lower incisor broken

The patient was able to leave that day with a fixed temporary.  The only thing he needed to worry about was not to chew in that area for 4 months while the implant undergoes the osseointegration process and becomes more solid.  After 4 months, I took impression with shade matching tabs and made a new final crown for him.  Pain is minimal… Usually you would only need ibuprofen.

impression post coping
Shade matching tabs

He was fortunate and that even though his teeth are skinny they were well aligned so replacement was more straightforward.  Sometimes if one or 2 of the lower incisors are crooked or “bad” it is better to remove 4 of them and place 2 on each side with a dental implant bridge.

final cemented titanium abutment
case complete
final crown close up

Sometimes computer guided placement is necessary in these very tight spots.

Because of good planning and treatment, the patient regained all gum triangles ( papilla) through proper forming and shaping of gum tissue.  This leads to a nice result and not an implant that is too long at the gum line.

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

7 thoughts on “Lower Front Tooth Dental Implant –Immediate Tooth Replacement

  1. I had a root canal done 8 years ago on my lower front tooth. The tooth later darkened and weakened.
    Most recently my grandson’s head hit my teeth breaking my lower tooth.
    On the same day, my periodontist extracted the tooth and placed an immediate dental implant into the socket with a small bone graft. It’s been 3 weeks I had this done and I still feel a little numbness with this lower part of my teeth. Is this normal? My doctor says it will gradually go away. Should I be concern?

  2. Hi Dr. Amin,

    I just had two bottom front implants. My lower central incisors were baby teeth, the adult teeth were missing. So the space for two implants was tight. I got braces to make more space, but my left lateral incisor wasn’t moving with the root fast enough, so that root stayed at an angle. There was enough space still to put the two implants, which were screwed in straight down (after a bone graft–baby teeth left very thin gum area)…

    Now the implants don’t seem aligned with my other teeth, especially the lateral incisors on either side. Because of the angled lateral incisor, it is not straight like the implant tooth is, and there is no gum triangle there. The implant screws also end right at the gum line, so there is no curved gum above the two implant teeth.

    My question is, could this be done better, knowing that I was working with tight space because of baby teeth, not enough bone, and a lateral tooth that was slightly angled at the root? My dentist says because she is following the way my oral surgeon placed the implant, it’s not possible to change the crown to be aligned with the other teeth.

    Also is it possible my gum could grow over the implant teeth from the bottom and the triangle area?

    1. the lower front area is a very challenging location because the teeth are so narrow and the roots are so close to each other. I was trying to find an article that I wrote some years back with an example of placing one single implant in the center and having two teeth on the one implant. That works quite well in many scenarios.

      Make sure to go through the temporary phase first with these implants before committing to the finals. Working with the temporaries is going to help shape and form the gum tissue. If it does not then I would look at alternatives or settle for some imperfections. Hopefully you are seeing a high-level expert in the field. Making the teeth is going to be just as important/complex as the surgery itself.

      Based on your description it sounds like you have screw retained temporaries. The contour of the abutment needs to be ideal in order to form the gums.

      If you remind me I will try to do a new post on this particular topic for you when time allows

  3. I had oral head Cancer in 2012.I had surgery now I’m Cancer free.but my face is disfigured and I don’t have to many teeth.my doctor says I looks ok and to fill my face out would be a lot of money.

    1. perhaps medical coverage can help you. You have unique circumstances. Consider having worked on a dental school since you have had head and neck cancer. Good luck

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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.