How to Transform the Esthetics of Implant-Supported Restorations with Gingival-Shaded Ceramics

Restorative Challenge A male patient in his early 20s presented with the chief complaint of unesthetic restorations and lost gingival architecture. He had lost his four maxillary incisors (teeth #7 through #10) due to trauma and despite successful implant surgery, was fitted with poorly designed restorations that he had worn for about a year. Treatment Plan The challenging aspect of this case was that one of the implants was improperly placed between #7 and #8. Therefore I couldn’t make a complete screw-retained implant bridge because the access hole between #7 and #8 would have diminished the esthetics and the axis of the screw would go right through the incisal edge. Instead, I made a screw-retained zirconia framework with pink gingiva tissue to recreate the lost gingiva and then cemented on four single crowns made from IPS e.max (from Ivoclar Vivadent) to the framework.