Lower Front Tooth Implants

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.

Special Considerations Lower Front Teeth Implants


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 considered 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

Healing After Front Tooth Implant

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

34 thoughts on “Lower Front Tooth Implants”

  1. With the case above, how is the implant doing now? How long do mandibular central incisor implants last? Can they last a lifetime?

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  2. I have a failed root canal and abscess on the same front tooth as in this article and I hope my dental surgeon does as good a job. Too bad I am in NY and not near Burbank.

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  3. Hey Doc, I have a question. I had one front incisor broken off because of me eating pizza (and also the dentist didn’t put a permanent filling after a root canal on it so it didn’t hold the tooth), and recently the other one on the opposite broke off. Would I be able to get two implants? I still have the other two front bottom teeth though. Those guys were said to be okay.

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  4. Hi Dr. Amin,
    I’m 50 years old from Egypt and lately my lower front teeth started moving when touched and developing painful gum infection. My dentist suggested immediately removing them along with the canines and one side back molars and using implants instead. Is this the best option? I’m really worried and could not take a decision. I would appreciate if you could help.
    Thanks,
    Lamia

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  5. I have tried to post before but never seem able to actually make it work. 33 years ago I lost two front lower incisors in a car accident. I had another incisor removed because it was at risk and loose. I had two implants and a bridge at that time recently they became infected and had to be removed. I’ve lost quite a bit of bone around my last lower incisor putting it at risk of loss. The only thing offered me is a two implant four teeth bridge. This is what was available 33 years ago. Is that all that can be offered 33 years later. I’m very unhappy with this choice

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      • Thank you so much for your reply I have had a three tooth bridge there for many years. I definitely understand what you are saying and since I’m losing another tooth that is unstable right there I will have a four tooth bridge as you have shown. I would like to know when they may be coming out with something better that will be stable. I know we have made great strides in this field but 33 years ago this would have been the same procedure offered. Not much progress there. I’m disappointed in this fact and hope someone tries to advance the ability to offer more at some point soon Some people don’t like bridges period. Especially in the front of the mouth. If we don’t continue to strive for improvement of techniques skills and materials we will never advance. Again thank you for your time and opinion

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      • Dr Amin. I have contacted you before about the four lower incisor implants. I wondered how do you keep the gum line up to the teeth level with only two implants and a bridge in the four lower incisor area. If I understand correctly with no bone stimulus there the bone deteriorates and the gum recedes in the areas where the false teeth are located. Also will not the bone thin in that area making the teeth hang over the gum ridge line My teeth were lost in an accident then the implants were lost 33 years later taking the fourth incisor with them. How can the bone be built up again to look normal without using any pink filler. The images you show look good and natural but in my case I don’t see how that can be achieved without using fake gum which I’m very opposed to

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        • Dr Amin. I have more questions for you. I recently saw an article on restoring two lower central incisors on one implant. I am missing three incisors and probably need the fourth removed because of bone loss. The first three were lost due to a car accident. The fourth because of implant infection with bone loss. My question is this. Would it be possible to put three implants in this area replacing the four incisors one of which would carry two teeth in the middle. I have a lot of bone loss and will need a bone graft but could this be a viable compromise to a four unit bridge. I am trying to find something that would have longevity but still be aesthetically pleasing to me. My second question is that I believe because of my bone defect you mentioned a bone block graft. I have heard that any vertical bone height graft would not last. I have researched this and found data collection for only up to 5 years. What is your experience with this. Although I am so wanting aesthetically pleasing restoration I also wish to have longevity of that restoration. If you don’t put three implants in how do you keep the gum level up to the center of the bridge because of lack of implants there. Thank you. I know it is a lengthy question

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          • Vertical bone height graft would will last. That being said it is a very difficult and demanding surgery that is mastered by only a few dentists. Any teeth that are questionable should be removed and the lower incisor area. They are too unpredictable and small. One implant cannot support 3 teeth in this area. Usually 2 implants for 4 teeth would be fine. The area under the missing teeth can be grafted with materials that do not resorb over time and will maintain the bulk. There is also options for root banking through socket shield which I do quite often to keep the bone from shrinking.

  6. I have two bottom front tooth are lose and will possibly need to get them remove. Since the space are smaller and tight would I need 1 implant or 2 to support the tooth?

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  7. I’m a 17 year old teenager, and I discovered some cracks in both of my lower front teeth that seemed to run down below the gum. I’m feeling a bit of pain coming from it. Wil it be serious??

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  8. I’m a 17 year old teenager, and I discovered some cracks in both of my lower front teeth that seemed to run down below the gum. I’m feeling a bit of pain coming from it. Wil it be serious?

    Reply
  9. 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?

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  10. 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?

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    • 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

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  11. 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.

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    • 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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