– Hi everyone, how you doing? So in this video let's talk about implants for front teeth, okay? So this is usually when people have had a tooth broken off at gum line. Maybe this tooth is
have root canal feeling. Maybe some posts, some crowns. You had a load of work done to this tooth. It's become weak it's just
broken off at gum level. What is the the way that you
can have this front tooth. And why is an implant and the front so different to an
implant at the back, okay? So let's go straight into. I'll show you this case which we treated fairly recently. I think we fitted the
crown fairly recently in the last three, four months. And we actually started
it a year before, okay? So this is just one way of doing it. And I'm gonna show you in my next video a kind of a much quicker way of doing it. Which you can do in certain situations. But this is a long winded case. You can see it's pretty obvious which tooth is missing and
you can see on the after photo on the right there that we
got pretty good end result.
It's pretty difficult to see
which one the implant is, okay? But I'll show you the giveaway signs a little bit later on in this video. Before we do that I'm
gonna cut this image. So we got a side on view, okay? Where the line is on the before photo, that's how we're gonna cross it. And then we're gonna
effectively just open it up and have a look at the side. Because I want show you certain things which are almost certainly going to happen as soon as you take a tooth out. And stuff which is gonna compromise the look of our dental implant. So this is that cross section, okay? So towards the right of this image we've got the front of the tooth. And we've got the tooth in
this kind of position here. So about a third of the
tooth is what you can see. Two thirds is up inside the bone, and that is the root of the tooth.
Now, the important thing here is that we can see this
junction here, all right? This junction is where the
gum and the two meet, okay? It's where the pink stops and the white of the tooth starts. From a cosmetic point of view this is a very important junction. Now, if we're gonna take this tooth out, one thing that would
almost instantly happen. When I say instantly within the next two or three months of having the tooth out, is that we're gonna lose bone, okay? When we lose the bone what happens is you take the tooth out and the bone around the tooth is very closely linked to
the surface of the tooth. And that starts to disappear
usually from the front and a little bit of the height. So it changes the look of the tooth in that area or the gum. And quite often you've
still got enough bone to place an implant, okay? But if you just place an implant you can get a couple of problems.
So let's remember, this is
where the tooth was, okay? When the gum was complete. And now to put an implant in and we put a tooth in the same place, cosmetically make it look the same. What would then happen is that junction where the tooth came out of the gum originally when the tooth was in position has now moved up a couple of millimeters. This gives us the illusion or it makes it look like that tooth on the implant is longer. And this is the big difference between having an implant
at the front of the mouth to having it at the back. So here's a photo of a lady who's had an implant at
the front of her mouth. And this has been disregarded by everything that I've
just spoken to you about.
She's had the implant placed. And you can see, I'm
not even gonna point out which tooth it is. But one of these teeth is much longer at the gum
level than the others. So this is in my opinion, it's a cosmetic disaster, all right? The patient wasn't overly
happy with the end result. Just to keep my ego going, it wasn't me who actually
treated this lady. I did see her for an emergency a little bit later after she had it done. And I 100% believe that the dentist who did this was trying to achieve the best result for their patient. And maybe they've done a whole
bunch of implants elsewhere, and they knew how to do it. But in this situation being
in the front of the mouth, there's a different set of
rules that we got to play by. And there's different techniques on how to achieve a good
result in these situations. In addition to the tooth being long, can you also see that
at the neck of the tooth is actually much more gray? And that's because the gum is so thin that we're getting show
through of the implant.
Or maybe the abutment which is connected to the implant. But there's some metal behind the gum and that's why the gray
is showing through there. Now, what can we do to fix this? Well, we've got two main options. And the way that we tackle
it from patient to patient is very individual, okay? There's a whole bunch of factors which are taken into account. And sometimes we may do
both of these two things. But let me just go
through them with you now. So we've got that same kind of diagram which I showed you at the beginning. But the only difference
is I've drawn a black line and that signifies the
bone underneath the gum.
And essentially, we've got enough bone to put an implant in there. Our main problem is that it's sunk in. So we've got a lack of
volume from the front and maybe a little bit to the height. So it's possible to take some gum usually from the back of the mouth, and transplant it and put it underneath the gum at the front, okay? So this sounds really horrible and a lot of people will want to run away when I explain this. It's no worse than
having a tooth taken out. And with any of these kind of procedures you should expect two or three days of swelling and being uncomfortable. Usually there's not a
massive amount of pain but the swelling is much worse than any discomfort that you're gonna get. Anyway, we take the gum from the back and we place it underneath
the gum at the front where we've lost all this bone, okay? And this creates a thickness.
It creates volume back into the area. And we're only doing this
for cosmetic reasons. We don't need this to
put an implant in there because we've got loads
of bone behind there. Now, this is a really neat option. I really like this because we're using the
patient's own stuff all the time. Their own gum that you have taken from one place to another. We're not using any additional
what we call biomaterial. Nothing that's been brought in
or taken from other animals. Although that stuff works. It's just neat and tidier if you've got the patient's
own stuff there all the time. So that's one way. The other way of tackling this problem is to actually address the bone, okay? So the problem is the bone
itself has shrunk away. So we do a bone graft and we thicken up the volume of the bone. And then we use the same
gum from the outside to cover that new volume of bone.
So it's a different technique. We can still use the patient's own bone. We can take it from
somewhere else in the mouth and place it on the front. But a more typical way of
doing something like this is to use like a bone grafting material. Which is ultimately derived
from either cows or pigs. And there's membranes. And stuff like that. It works really well for
small amounts of bone that we want and it's very convenient to just open a bottle
and pack it on there. And then what happens is your own bone grows
into that graft material and over time it will become firm like your own bone, okay? So that's really neat.
That's our second way of doing it. So with both of these two techniques. The goal is to increase the
volume at the front here so that we can put a tooth on there and then that tooth
will look correct, okay? So that junction which I spoke about where the gum and the tooth meet, we call that the emergence profile. It's how the tooth emerges out of the gum. And this is what we're trying to do with these front implants to try and get it to look
as natural as possible. Now, let me walk you through
how we did this case. Because it wasn't easy or straightforward. Now, the history is this
is a young lady, all right? When she smiles she can see the gum. And it's really important that we get the symmetry correct in order to achieve these ideal aesthetics that we're looking for. And we know that having
this tooth taken out is gonna reduce the
amount of gum and bone. So what we did… She actually had two veneers
on the front two teeth and one tooth was very weak because she'd broken it as a kid.
She'd had a root canal. She'd had a post one of
the root canal treatment. So she'd had it waken the tooth a lot. And something happened and suddenly it just won't crack and
that was it, it broke. So we took the tooth out. We used that same tooth. We cut the tip off it,
cut the root of that tooth and used it as a temporary measure and glued it to the
teeth either side, okay? Because this is a long process. She can't be without a tooth. She's a doctor. She's in the front facing role at work. And she's got a family, a social life. She can't be without a front tooth. So we had to make her a good front tooth and not a removable denture, okay? As a front tooth.
I don't like removable
dentures as temporary solutions because they can put pressure on the gum which we would like to avoid if we can. So anyway, we've got the temporary done. And from the other angle you can see this reduction
in bone that we've had. So if I just draw some white lines on here you can see along the natural tooth where we still have all of this bone, we've got a nice kind of um… We call it a root eminence
where you can feel… You can feel this with
your finger actually. Just rub your finger over
the teeth which you have and you'll feel a little
bump over the top. And that's the root beneath the bone. And when we've had the tooth taken out it's much flatter because
the bone has shrunk in and that means the gum follows it. So we actually did a
tissue graft at the time of placing the implant in. And this is the situation
soon after that, okay? If you look at it, it's
not much better, okay? We have increased the
thickness a little bit but let me show you side on and you can see what it
looks like, all right? And the neck of this tooth just doesn't look natural, okay? Because the gun is in
and the tooth is forward.
The tooth is pretty
much in the right place. Yeah, there's certain features about it which we need to still improve. But this emergence which is the really difficult thing here is completely wrong. It's like the tooth comes
out and then goes down. Which in some cases we need to do. But in single implant
crowns, we can avoid this. So we actually did a second
tissue graft for her. Once the implant was
already in place we… And this is the only
time I've actually done a tissue graft with the implant in place, especially on the (murmurs) place. And then we took additional
gum from the back. We placed it inside. Let it heal. And it looked a lot better. So the photo on the left is just when the implant went in with tissue graft number one. And then the photo on the right is with tissue graft number two. And you can see we've got
a bit more of this bulge around the implant tooth. That's what we're aiming for, okay? So then we go through our whole process.
She had the implant tooth on one tooth and then we redid the
veneer on the other side to create the symmetry. One space was bigger than the other. So we had to use certain techniques to give the illusion that
the teeth are the same. If I'm gonna be really critical which I always am on
dental work like this, the implant tooth is slightly brighter than the natural tooth. Because the natural tooth we've got the yellowness showing through. This can sometimes be compensated for by having a whiter veneer
which will tone down when you've got that
natural tooth underneath. But because we did the second tissue graft on this tooth here, you
can see a thin scar tissue, scar line above the tooth. You can see the light reflects a little bit differently on there. So we always want to avoid scar tissue and scar lines like this. In reality, the patient
didn't notice this. And she had a mirror right
up close to her teeth trying to spot the
difference between the two. She didn't see that. But it's something that
as a cosmetic dentist we're trying to push the boundaries and get even better and better.
Now, as I say this is one way of doing it. This is what we call the
delayed method, okay? So you take the tooth out. You let the bone shrinkage happen. You see what you're left with. You choose the right, either bone grafting or tissue grafting and you build up the the defect left by
taking the tooth out. And then we place the implant and then make really good temporaries. Get looking right in temporary teeth first and then you move to porcelain, okay? So that's the kind of
fail-safe way of doing it. The downside is it takes a long time. But if you've actually got
the route still in place then there is a better way
of doing it, in my opinion. So I'm gonna shoot another video and hopefully get it out
in the next week or two and I'll show you the
process of doing an implant when you've actually
broken the front tooth off and the root is still remaining, okay? Because it's a totally different scenario.
And it's a slightly different technique. But the cool thing is you
get your tooth a lot quicker. The end result is achieved
much more quickly. So I hope you found this useful. I hope you found it informative. If you've got questions, comments, you can put them below and I'll try and get back to everyone. If you wanna find out more about me you can find me on different
social media channels. You can have a look at my
website for consultations. If you're in our local area I'd love to meet up and talk to you about
your solutions, okay? So until next time, take care..
