Cosmetic Dentistry: Two cases showing how dental implants can be used to replace missing permanent teeth.

People are sometimes missing one or more of their permanent teeth. If the teeth really are absent, as opposed to still lying in the jawbone, a great way to replace them is with dental implants.

An implant offers a way to replace a missing tooth without having to involve or disrupt the integrity of neighboring teeth. The digital makeovers on this page provide examples of cases where implants might be used.

Digital smile makeover #1: Replacing two missing lateral incisors with tooth implants.

Dental history and concerns:

1) This person looks like they have a full set of teeth but, in reality, the shortest uppers you see in this "before" picture are baby teeth. The permanent teeth (lateral incisors) that were meant to replace them never came in.

2) The way this smile looks right now seems fairly reasonable. The problem is the baby teeth can't be expected to last a lifetime. Some years down the line they will likely develop some type of problem where they need to be extracted and replaced.

3) The "missing" lateral incisors either don't exist (never developed), or else are impacted (misaligned and still within the jawbone).

4) The vague band of white stain that runs across midsection of the center two teeth is likely evidence of fluorosis. A condition caused by the ingestion of elevated amounts of fluoride during tooth development.

Cosmetic dentistry solutions:

1) A dental-implant approach. - If the permanent lateral incisors really don't exist, then the plan that's needed is to extract the baby teeth and then replace them with full-sized artificial ones. Dental implants would make an excellent choice for this case. And this is the approach we've illustrated in our "after" picture.

Implants, more so than any other type of dental restoration, come closest to mimicking the natural teeth they replace. An implant is firmly embedded in the jawbone (it's not removable like a partial denture). And the implant's crown is independent of adjacent teeth (unlike a dental bridge where the false tooth is attached to its neighbors).

2) An alternative plan. - If the permanent laterals still lie misaligned in the jawbone, an alternate approach for this case would be to expose these teeth (a minor surgical procedure) and then guide them into place using orthodontic treatment (braces).

This approach would take longer than having dental implants placed. But the advantage would be that no artificial teeth would be needed.

3) Masking the fluorosis. - It seems likely that the fluorosis staining could be masked by performing either at-home or in-office teeth whitening treatments.

Digital dental makeover #2: Replacing a missing lateral incisor with a dental implant.

This case is similar to the one above, replacing a missing lateral incisor with an implant.

Dental history and concerns:

1) When you look at this "before" picture you can see that there is a space between teeth #'s 1 and 2. This is the position where this person should have a lateral incisor. There is also a space between her two center teeth.

This lateral incisor is either really missing, or else lies impacted in the jawbone. Because the tooth is absent, the neighboring incisor has "drifted" back, thus creating the center gap.

Cosmetic dentistry solutions:

1) Some tooth repair is required. - This person's eyetooth (the tooth with big part missing) has a large cavity and needs immediate attention. Its repair could probably be made by placing a white filling (dental bonding), if not, then a dental crown.

2) Orthodontic treatment will be needed. - There simply isn't going to be any way to properly correct this smile without the use of orthodontic treatment (braces). Space needs to be made for a lateral incisor. And the center gap needs to be closed. (Also shown in our "after picture, braces could be used to correct the misalignment of the lower teeth.)

3) Placing a dental implant. - If the lateral incisor really is missing, then it could be replaced with a dental implant. The space where the implant needs to go would have to be widened (so the implant's crown can be full-sized). This treatment, in turn, would also close the gap between the center teeth. (It might be possible that this orthodontic work could be performed using Invisalign ® removable braces.)

For the reasons described above, dental implants have some inherent advantages over partial dentures and bridges. When conditions are right for them, they can make an excellent, lasting choice.

4) An alternative plan. - There is a chance that the missing lateral lies impacted in the jawbone. If so, and as describe above, it could be guided into place using orthodontic treatment. The advantage of using this approach would be that no tooth implant would be needed.