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What this case cost
$287/month
144 payments at 9.99% APR, on approved credit.
Total: $24,000 for the gum lift, six porcelain veneers and two implant crowns.
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Treatment Plan by Dr. Mehdizadeh
- Comprehensive smile analysis accounting for existing implant positions at #6 and #11
- Gum lift (gingival recontouring) to create even, uniform gum architecture across all teeth
- Digital design of slender tooth proportions to replace short, wide tooth appearance
- 6 porcelain veneers on natural teeth with custom shade matching
- 2 new implant crowns on existing implants (#6 and #11) with custom zirconia abutments
What Are Congenitally Missing Canines and How Are They Treated When Implants Already Exist?
This patient was born without her upper canine teeth, at positions #6 and #11. Congenitally missing teeth are permanent teeth that never develop due to genetic factors; wisdom teeth are the most commonly absent, but upper canines are among the more functionally and aesthetically significant teeth that can fail to develop. As a teenager, she had two dental implants placed to replace the missing canines, a reasonable solution at the time. She now needed a treatment plan that would work with her existing implants rather than against them.
After she received her implants as a teenager, her natural teeth continued to shift and move as her jaws developed through her late teens and early twenties. Dental implants do not move: they anchor directly to the bone through a process called osseointegration. Her implants now sat higher than her natural teeth, creating an uneven smile line that orthodontics could not correct. The implant crowns also looked short and wide next to her natural teeth, further disrupting the visual harmony of her smile.
“The implants stayed in position while everything around them moved. We needed to bring harmony to a smile that had grown apart.”
Why Not Remove the Old Implants and Start Over?
The most direct question patients ask is why not simply remove the existing implants and place new ones in better positions. Removing osseointegrated implants is significant surgery that destroys surrounding bone, requires extensive bone grafting to rebuild the extraction site, and means starting the entire implant process over from scratch with 6–12 months of additional healing. For implants that are otherwise healthy and well-integrated into the bone, this level of intervention would be medically excessive and would subject the patient to unnecessary surgical risk. Instead, Dr. Mehdizadeh designed a treatment that kept the healthy implants and addressed every aesthetic concern through less invasive means.
The Clinical Challenge
Two healthy implants sitting higher than ideal, natural teeth that had shifted over years of growth, short and wide tooth proportions, and a desire for a harmonious smile—all without removing the existing implants.
How Did the Gum Lift Create the Foundation for Symmetry?
We planned the treatment around the implant positions rather than against them. The first step was a gum lift, in which Dr. Mehdizadeh reshaped the gum tissue to create even, uniform arches across all teeth. This accomplished two critical goals: it leveled the gum line to reduce the visual impact of the higher implant positions, and it exposed more natural tooth structure that would allow for the creation of more elegant, properly proportioned teeth.
Before the gum lift, her teeth appeared short and wide because excess gum tissue covered a significant portion of the crown. By recontouring the tissue with microsurgery, he gained the vertical dimension needed to design slender, naturally proportioned teeth. Healing time for gum tissue stabilization was approximately 6–8 weeks before proceeding to the veneer preparation phase.
How Were Veneers and Implant Crowns Designed to Work Together?
With the gum architecture optimized, the restorative phase began. We placed six porcelain veneers on her natural teeth, designed to complement the new gum line and create ideal proportions with slender, elegant forms rather than the previous short and wide appearance. The two existing implants at #6 and #11 received new crowns meticulously crafted to blend seamlessly with the veneers despite their slightly higher position.
Custom Zirconia Abutments: The Hidden Foundation
A critical detail in this case was manufacturing custom zirconia abutments for the implant crowns. Standard abutments consist of titanium or gray metal, which can show through translucent porcelain and create a grayish appearance at the gum line. Custom zirconia abutments match the color of teeth, supporting natural-looking gum tissue and preventing any metal color from showing through the crowns.
- 6 porcelain veneers with slender, elegant proportions replacing short, wide tooth forms
- 2 implant crowns on custom zirconia abutments designed to harmonize with veneer aesthetics
- Elegant surface texture for natural light reflection
- True symmetry achieved through careful gum and restorative planning
- Subtle translucency matching natural tooth characteristics
What Was the Final Result After 16 Weeks?
Treatment took sixteen weeks from consultation to completion. The result looks natural, with proper light reflection, true symmetry, subtle translucency and elegant texture. It is hard to tell she has implants, let alone that they sit higher than ideal. The gum line is uniform, the tooth proportions are in balance, and the overall effect is that of a naturally beautiful smile. Her implants remain healthy and functional.
“The result is flawlessly natural, harmonious. Elegant texture on the teeth. Proper light reflection. True symmetry. Subtle translucency. It has everything a natural smile needs.”
Frequently Asked Questions About Congenitally Missing Canines and Implant Harmonization
What are congenitally missing teeth?
Congenitally missing teeth are permanent teeth that never develop due to genetic factors. The condition is called hypodontia (1–5 missing teeth) or oligodontia (6 or more missing). The most commonly affected teeth are wisdom teeth, upper lateral incisors, lower second premolars, and upper canines. Approximately 2–8% of the population is missing at least one permanent tooth (excluding wisdom teeth). When permanent teeth fail to develop, options include dental implants, bridges, or orthodontic space closure depending on the specific teeth involved and the patient’s overall dental situation.
Why did the implants end up in the wrong position?
Dental implants placed during adolescence do not move as the jaw continues to grow and remodel. While natural teeth shift and adjust their positions through periodontal ligament-mediated movement over time, implants are fused directly to bone (osseointegrated) and remain fixed in their original position. This patient received her implants as a teenager, and her natural teeth continued to erupt and shift during her late teens and early twenties while the implants stayed stationary. This is one reason many implant specialists recommend delaying implant placement until skeletal growth is complete, typically age 18–21 for women and 21–25 for men.
What is a gum lift and why was it needed in this case?
A gum lift (gingival recontouring or crown lengthening) is a procedure that reshapes the gum tissue to expose more tooth structure and create even, symmetrical gum architecture. In this case, the gum lift served two critical purposes: leveling the gum line to minimize the visual impact of the higher implant positions, and exposing enough natural tooth structure to allow for slender, properly proportioned veneers. Without the gum lift, the teeth would have remained short and wide however well we designed the veneers.
Can existing implant crowns be replaced without removing the implant?
Yes. The dental implant is the titanium post integrated into the jawbone—the crown is a separate component that attaches to the implant via an abutment screw. We can remove and replace a crown without disturbing the implant itself. In this case, we kept both healthy implants at positions #6 and #11 and designed new crowns on custom zirconia abutments to harmonize aesthetically with the new porcelain veneers on the adjacent natural teeth.
What are custom zirconia abutments and why do they matter?
Abutments are the connectors between the implant body in the bone and the visible crown above the gum line. Standard abutments consist of titanium or other gray metals, which can show through translucent porcelain and create a dark or grayish appearance at the gum margin—particularly problematic in the smile zone. Our laboratory makes custom zirconia abutments from tooth-colored ceramic material, which supports natural-looking pink gum tissue and keeps any metal shadow from showing through the crown.
How long does gum lift healing take before veneers can be placed?
Gum tissue typically heals within 2–4 weeks after a gum lift procedure. However, we wait 6–8 weeks before finalizing the veneer design, so the tissue has matured and settled at its final position. Proceeding too early risks the gum line shifting after we bond the veneers, which would compromise the proportional design.
How much does a gum lift with veneers and implant crowns cost?
This case was $24,000, covering the gum lift, six porcelain veneers and two implant crowns. $287/month: 144 payments at 9.99% APR, on approved credit.
How long does this type of combined treatment take?
This case took approximately 16 weeks from initial consultation to final delivery. The timeline included gum lift surgery (week 1), gum tissue healing and maturation (weeks 2–8), veneer and implant crown preparation and laboratory fabrication (weeks 9–14), and final bonding and delivery (weeks 15–16). Cases with less extensive gum surgery may take 10–12 weeks.
How long do porcelain veneers and implant crowns last?
High-quality porcelain veneers typically last 15–20 years or longer with proper care. Implant crowns have similar longevity, with many lasting 20+ years. The implants themselves typically last many years when properly maintained. Maintenance includes professional cleanings every 6 months, avoiding using teeth to open packages, and wearing a night guard if grinding is present. Implant crowns may require periodic screw retightening at recall appointments.
Should implants for congenitally missing teeth be placed during adolescence?
It is best to delay implant placement until skeletal growth is complete—typically age 18–21 for women and 21–25 for men. Implants placed before growth completion may end up in suboptimal positions as the surrounding bone and teeth continue to develop. Interim solutions such as removable retainers with prosthetic teeth or resin-bonded bridges can maintain space and aesthetics until the patient is old enough for implants.
