Dr. M. asks:
I have a patient who is a beautiful woman with this huge diastema between her maxillary central incisors. I think if I placed an implant between them I could fit in a crown that would add harmony and balance to her smile line. Have any of you tried to solve this particular aesthetic problem with an implant solution like this?
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Think about orthodontics. Less invasive and definitively more predictable option.
JM is absolutely correct, but if you need to replace the with implats because they are damaged somehow, use the ortho to get them in the right position and in the best possible relation, then replace them and with inmediate loading you can pretty much preserve the papillae ( that is vital)an that will get you a better cosmetic result
This is an ortho and restorative case. Not an implant case.
Dr M, Some people do not want to go for ortho, for whatever reason.
In that case, you need to see how much is the space. Think how is it going to look if you put one more cental in the middle. I think it will not look good. If you put 2 mini and put 2 crowns, how will it look to have 2 smaller or very small centrals in the middle. Do you have enough space to do that way? Can you file the centrals to make more space?
You can use computer imaging to see how it can look. Let pt see how is it going to look. Then pt and you can decide. If pt gets convinced for ortho, nothing better than that.
I recenly had one pt with space Diastema larger than her centals. My son put 2 centrals in the space using photo shop program. I showed that to the pt. It looks better than having the huge space. But not as good as it would be with ortho. Pt has not decided yet.
Good Luck.
even if you have the space you most likely won’t have good bone where you need it
You can let the patient consider an adhesive bridge. If she doesn’t like it, you can always knock it out and do ortho which will yield much better results.
I think diastema in the mid line best than tooth in the mid line.
Are you talking about adding a THIRD maxillary central, so that she will have FIVE incisors?
I shudder to think of such a thing. Hardly esthetic. I would think a truly beautiful woman would have higher expectations for her smile.
Two more things to consider- you would be placing the implant through a suture line in the midline of the premaxilla (quality of bone) and you may have space issues with the nasopalatine canal as well(volume of bone).
I agree with some of the other posts- an ortho and restorative approach is the way to go.
always consider anterior maxillary midline.ortho can bring best result considering bone volume and nasopalatine canal for implant restoration .aesthtic restoration followed by orthodontic can bring best result