An expectation of a beautiful smile at the end of treatment is a primary concern for all patients, but most are also concerned with appearance while undergoing treatment. The anterior maxilla is often referred to as the aesthetic zone. Missing maxillary lateral incisors creates an aesthetic problem with specific orthodontic and prosthetic considerations, therefore treatment planning always poses a challenge to the clinicians.
Treatment alternatives for missing teeth include removable partial dentures, conventional fixed bridges, resin bonded fixed bridges, autotransplantation and dental implants. Treatment of tooth loss or agenesis in the anterior maxilla with single-tooth implant supported crowns is well documented. Depending on the type of final restoration that is chosen, interdisciplinary management of these patients often plays a vital role in the facilitation of treatment. One of the most common treatment alternatives for the replacement of congenitally missing teeth is a single-tooth implant. The main advantage of this type of restoration is that it leaves the adjacent teeth intact.
The healing period after implant placement by dental implant equipment is generally 3-4 months and the appearance of a gap from a missing tooth can be a concern during healing phase, especially if it is in the display zone of a patient’s smile. If the treatment plan includes prosthetic replacement of the missing tooth rather than space closure, then space maintenance is also an issue. In an appearance conscious patient, use of riding pontics as space maintainers is a good option during treatment.
Implant was loaded in the region of missing tooth under anaesthesia and post operative instructions were given. The healing period after implant placement was 3-4 months and the appearance of a gap from a missing tooth was a concern during healing phase, especially because patient had high aesthetic demands. So, an interim restoration was planned along with an Essix retainer.
Mesiodistal width determination – When a single anterior tooth is missing, mesiodistal width of the pontic should be determined by considering the width of the contralateral natural tooth. When teeth are missing bilaterally, the mesiodistal width of the pontic should be determined by analyzing the space available and the dimensions of the remaining natural teeth. So in this case, the mesiodistal width of the contralateral natural tooth was considered.
Height determination- The cervical end of the pontic should touch the gingiva with a smooth contour. If the cervical end of the pontic does not touch to the gingiva, then the negative space between the pontic and the gingiva can affect the aesthetics, especially in high smile line patients. The incisal edge or cusp tip of the pontic should be in harmony with the adjacent natural tooth for maximum esthetics.