Congenitally Missing Canines: Harmonizing Existing Implants

Working with Existing Implants: A Design Challenge

This patient presented with a unique challenge that required creative problem-solving. She was born without her upper canine teeth—a condition known as congenitally missing teeth. As a teenager, she had two dental implants placed at positions #6 and #11 to replace the missing canines. At the time, it was a reasonable solution. But the body had other plans.

After her implants were placed, she continued to grow and mature. Her natural teeth shifted and moved as jaws develop through adolescence and early adulthood. But implants don't move—they're anchored directly to bone. The result: her implants were now positioned higher than her natural teeth, creating an uneven smile line that no amount of orthodontics could fix.

"The implants stayed in position while everything around them moved. We needed to bring harmony to a smile that had grown apart."

The Problem with Replacement

The obvious question: why not just remove the old implants and place new ones in better positions? The answer lies in surgical reality. Removing integrated implants is significant surgery. It destroys bone, requires extensive grafting, and means starting the implant process over from scratch. For implants that are otherwise healthy and functional, this level of intervention would be excessive.

The Gum Lift Solution

Rather than working against the implant positions, we designed around them. The first step was a gum lift—a precise reshaping of 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 tooth structure that would allow us to create more elegant tooth proportions.

Before the gum lift, her teeth appeared short and wide. By carefully recontouring the gum tissue, we gained the vertical dimension needed to design slender, properly proportioned teeth. The gum lift alone transformed the foundation upon which we would build.

Veneers and Crowns Working Together

With the gum architecture optimized, we moved to the restorative phase. Six porcelain veneers were placed on her natural teeth, designed to complement the new gum line and create ideal proportions. The two existing implants received new crowns—meticulously crafted to blend seamlessly with the veneers despite their slightly higher position.

• 6 porcelain veneers with slender, elegant proportions
• 2 implant crowns designed to harmonize with veneer aesthetics
• Elegant surface texture for natural light reflection
• True symmetry achieved through careful planning
• Subtle translucency matching natural tooth characteristics

The Result

Sixteen weeks from consultation to completion. The result is flawlessly natural—a smile that has everything it needs: proper light reflection, true symmetry, subtle translucency, and elegant texture. Most importantly, no one would ever know she has implants, let alone that they're positioned higher than ideal.

This case demonstrates that dental imperfections don't always require perfect solutions. Sometimes the best approach is designing around existing conditions rather than fighting against them. Her implants remain healthy and functional, while her smile is now everything she wanted it to be.

"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."