Single tooth implant replacement in the aesthetic zone
29-year-old female
§Chief complaint
Missing upper front tooth after a sports injury 6 months ago
§Medical & dental history
- 01Healthy non-smoker
- 02No bisphosphonates or uncontrolled diabetes
- 0311 avulsed and not replantable; currently wearing a removable partial denture
§Clinical examination
- 01Healed edentulous 11 site with a mild horizontal ridge defect (Seibert class I)
- 02High smile line exposing full gingival margins
- 03Adjacent teeth 12 and 21 vital, unrestored
- 04Good oral hygiene, no periodontal pockets over 3 mm
§ figuresFigures (3)
Fig. 1The x-ray controlling from 1976/77 shows an subperiosteal implant (according Cherchéve) in the maxilla. Two implant tripods (according Pruin) in the lower canine region and two stabilized blade Implants (according Heinri
“Panoramic radiograph of historic dental implants” · Dentistxxx · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2Dental radiograph depicting both platform switching and platform matching dental implants
“Platform switch” · DRosenbach · CC BY-SA 3.0 · Wikimedia Commons
Fig. 3Dental radiographs demonstrating different emergence profiles on a lower left implant crown.
“Emergence profile” · w:user:DRosenbach · Public domain · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Dental Implantology figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Single edentulous space at 11 suitable for implant rehabilitation after horizontal ridge augmentation
The adjacent teeth are sound and unrestored, so preparing them for a conventional bridge is unjustifiable. A high smile line raises the aesthetic risk and mandates ridge augmentation and careful three-dimensional implant positioning.
§Investigations
- 01CBCT — 5.5 mm buccolingual ridge width, 16 mm vertical bone height, nasopalatine canal mapped
- 02Digital intraoral scan and diagnostic wax-up
- 03Photographic smile analysis and aesthetic risk assessment
§Treatment plan
- 01Guided bone regeneration for horizontal augmentation, then delayed implant placement
- 02Fully guided implant surgery using a surgical stent from the wax-up
- 03Provisional crown for soft tissue conditioning before the definitive screw-retained crown
- 04Maintenance programme with 6-monthly peri-implant review
§Surgical procedure
- 01Stage 1: GBR with particulate xenograft and resorbable membrane
- 02Stage 2 at 6 months: guided placement of a 3.5 x 12 mm implant, 3 mm below the planned gingival margin, 2 mm palatal to the emergence profile
- 03Connective tissue graft for buccal contour at second-stage uncovering
- 04Screw-retained provisional at 3 months, definitive zirconia crown at 6 months
§Follow-up & outcome
- 01Osseointegration confirmed clinically and radiographically
- 02Pink aesthetic score 12/14 at 1 year
- 03Stable marginal bone level at 2 years; peri-implant tissues healthy
§Clinical pearls / learning points
- 01Implant position is prosthetically driven — plan the crown before placing the implant.
- 02A high smile line is the single biggest aesthetic risk factor in the anterior maxilla.
- 03Peri-implantitis prevention starts with adequate keratinised tissue and cleansable prosthetic contours.
§References
- Buser D et al. Optimizing esthetics for implant restorations in the anterior maxilla.
§Similar cases
41 cases in the library