How porcelain veneers can be used in combination with dental implants
Some patients are looking for a smile makeover with porcelain veneers while having existing implants. This dental condition can be challenging for several reasons:
- Position and emergence profile of dental implant, abutment, and implant crown.
- Health of periodontal tissue adjacent to dental implant and abutment.
- Preservation of interdental papillae
- Symmetry of gingival margins at teeth and implant crowns.
- Color of implant abutment
Successful comprehensive cosmetic dentistry relies on meticulous diagnosis, carefully sequenced treatment planning, and the highest level of treatment execution by the cosmetic dentist. Many conditions have to be addressed prior to designing a new smile. The numerous conditions to be considered include missing teeth. While some of them have been replaced with dental bridges, the advancement of dental implant technology and oral-tissue management have made dental implants the treatment of choice for missing teeth.
There are many excellent publications about complex oral challenges that are managed with this treatment modality. I have chosen a simple case to make it easier to understand the asethetic aspects of smile makeovers with porcelain laminates when dental implants are in the aesthetic zone.
The patient in the image above wants to get a smile makeover.
He is not happy with the dingy appearance of his teeth.
He has one dental implant at the upper left central incisor.
The gumline around the implant assembly is close to symmetric to the gumline
of the contralateral natural central incisor. Hence, changes at the gum level are
undesirable. The periodontal tissue appeared healthy and the implant and
abutment under the exisitng crown appeared to be well connected.
This image shows the occlusal view of the dental condition prior to redesigning
the patient's smile. Defects of the current dental bonding are clearly visible.
The lingual composite plug abve the retention screw for the abutment is clearly
noticable. Clinical and radiographic evaluation revealed complete integrity
of the implant-abutment-crown assembly.
We therefore decided to preserve the existing implant assembly and minimize the removal of existing structure. We were able to successfully provide sufficient space for a porcelain veneer that would be bonded onto the exisitng dental implant assembly. The porcelain veneer would be designed the same way as all the neighboring porcelain veneers that were created for the new smile design, using the identical dental materials.
This image shows the occlusal view of the upper dental arch after placement
of porcelain veneers at the upper front teeth, including the dental implant.
This smile makeover eliminated several shortcomings of the prior dental condition while the close to symmetric gum line at the central incisors (natural tooth versus implant) was preserved. The shades were carefully chosen to harmoniously and naturally integrate the porcelain veneers with the natural dentition.
Dental condition prior to the placement of porcelain veneers.
Dental condition after the placement of porcelain veneers
The New Smile With Porcelain Veneers and a Single-Tooth Implant in the Aesthetic Zone.
Shah KC, Lum GL. Treatment planning for the single-tooth implant restoration--general considerations and the pretreatment evaluation. J California Dental Association 2008, 36 (11), 827–834.
Spear FM. The Use of Implants and Ovate Pontics in the Esthetic Zone. Compendium 2008, 29 (2), 72–80.
Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontology 2000, 71 (4), 546–549.
Torreão AS et al. Single-unit implant-supported restoration in the vertically deficient anterior maxilla. Pract Periodontics and Aesthetic Dentistry 1999, 11 (5), 571–575.
Spielman HP. Influence of the implant position on the aesthetics of the restoration. Pract Periodontics and Aesthetic Dentistry 1996, 8 (9), 897–904.
Chee WWL et al. Esthetic replacement of the anterior tooth with an implant-supported restoration. J California Dental Association 1997, 25 (12), 860–865.
Daftary F.. Dentoalveolar morphology: evaluation of natural root form versus cylindrical implant fixtures. Pract Periodontics and Aesthetic Dentistry 1997, 9 (4), 469–77.
Lum MG, Shah KC. A multidisciplinary approach to treatment planning the single-implant restoration: interdisciplinary coordination. Journal of the California Dental Association 2008, 36 (11), 837–848.