Implants in Esthetic Area neighbouring perio treated teeth: waiting interval?

Very difficult to advise without xrays to determine what the bone looks like. I would remove the frenum, graft the ridge 8,9 since the labial plate looks narrow. Another option would be using the lateral incisor extraction sites for a four unit bridge using 8,9 as abutments. This is impossible to treatment plan without a film and seeing how much recession you will get after the s/r. A good rule of thumb for tissue response would be 12-16weeks. The laterals are splayed out and the lower incisors appear to be supra erupted.

I woul proceed slowly with any implant treatment. The presence of periodontal disease is a clue! Give it time and determine if the patient can maintain proper oral hygiene. If so proceed. If the lateral incisors are questionable. Extract and fabricate a six unit FPD. CRS made viable suggestions (2 implants replacing the laterals and a 4 unit FPD and frenectomy) .

This is a classic Division 2 Anterior case: The flared upper laterals and the supra-erupted lower centrals indicate this should have been an orthodontic case years ago. The upper centrals were likely too vertical and thus did not provide stops for the lower centrals, leaving a "kicking" contact which is very destructive to the upper Labial Plate. A Perio exam may show that the anterior interferences were the major cause of the lost central incisors, not perio infection. By nature, these cases have tiny premaxillae - the laterals had to splay out labially and rotate to fit within the small bone. The best treatment would begin with perio treatment, then orthodontic/orthopedic widening of the Maxilla to allow adequate room for normally sized upper incisors. Yes, one could possibly do it with an 8 unit fixed bridge by shifting the posterior abutment preps distally. Doing so with 6 units would demand narrow cuspids or narrow laterals, or all teeth narrowed if set straight. The only way to put in normally sized teeth would be to place them as crooked as the original. So the question is whether the patient will, after Perio Tx, accept the needed Ortho Tx before restoration or demand some compromise in size, shape and placement. i.e.,There is not adequate space between the cuspids for normally sized and shaped incisors regardless of the prosthetic choice, fixed, removable, implants, etc..

This is a difficult case. The flipper will look much better than the final restoration. A bridge will be an easier solution. There will be no way to create good looking gingival contours with the lateral incisors as they are now. If the perio condition of the laterals does not rate at least a good prognosis then extraction and placement of implants for a 4 unit bridge may work. The site must be grafted to add labial bone. If you have not done a case like this in the past consult with your lab and with a more experienced doc before you start or it could get very costly.

You seem to express a better than average understanding of the importance of improved OH.. With class one mobility, I would discourage removing the laterals, in that this patient seems to be compliant with instructed changes. Even as a surgeon that does not restore implants, this deep bite has to be considered. I would strongly resist the urge to splint these implants to the laterals. " They " should tighten up a bit with the treatment rendered and the potential bone regeneration. Bv