Have you been wearing a flipper for years?
A removable partial rests on the tissue rather than loading the bone, so the ridge underneath it keeps resorbing and the appliance keeps needing adjustment. How much bone is left decides whether implants can go in directly or whether the ridge has to be rebuilt first. Send us a photo of your smile and we will tell you which situation you are in and what it would cost.
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What this case cost
$335/month
144 payments at 9.99% APR, on approved credit.
Total: $28,000 for whitening, bone grafting, three implants, an implant crown, a veneer and a three-unit implant bridge.
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Treatment Plan by Dr. Mehdizadeh
- Whitening of the natural dentition, completed before any restorative shade was recorded.
- Bone grafting to rebuild the resorbed anterior ridge.
- Three implants placed, at teeth seven, nine and eleven.
- Healing and osseointegration.
- One implant crown on the implant at tooth seven, and one porcelain veneer on the natural tooth at eight.
- A three-unit implant bridge spanning teeth nine to eleven, carrying tooth ten as a pontic.
The Patient's Journey
This patient was missing four upper front teeth — numbers seven, nine, ten and eleven — a lateral incisor on one side of the midline and the central incisor, lateral incisor and canine on the other. Only tooth eight, one of the two central incisors, was still standing at the front. He had been managing with a removable partial denture, a flipper, and had tolerated the arrangement long enough to be thoroughly tired of it. What he asked for was something permanent.
Understanding the Challenge
He also presented with severe bone loss across the edentulous span, and that finding, rather than the absent teeth themselves, determined how long this reconstruction would take.
Alveolar bone exists to support teeth, and the occlusal load they transmit into it is what maintains it. Extract the tooth and the stimulus disappears with it, so the ridge resorbs. Resorption is most rapid during the first year following an extraction and continues at a diminishing rate indefinitely afterwards, which means an edentulous anterior ridge that has carried no teeth for years is both narrower and lower than it was, sometimes markedly so.
A removable partial denture does not prevent this. The appliance rests on the mucosa and transfers its load to the soft tissue rather than into the underlying bone, so resorption continues beneath it undisturbed. That is why a flipper that fitted accurately at delivery becomes loose within a year or two and needs relining to the new contour.
Where the ridge has shrunk below the volume an implant needs to hold firmly from the day it goes in, Dr. Mehdizadeh rebuilds the bone first, lets it mature, and only then places the implant. That sequence is the reason this case ran seven months rather than three.
Rebuild the resorbed anterior ridge before placing anything in it. Replace four missing teeth with three implants. Bring the one natural tooth in the span into the new work. Whiten before any shade is recorded. Nothing removable at the end of it.
How We Approached Treatment
We whitened his teeth first, as we do in every case that finishes with restorations at the front of the mouth, because ceramic does not lighten. If we record the shade before whitening the natural teeth, the restorations are wrong as soon as the whitening ends, and the only remedy is to remake them.
Dr. Mehdizadeh grafted the ridge and left it to consolidate, then placed three implants into the reconstructed bone, at teeth seven, nine and eleven. Four teeth were missing and three implants replaced them, because tooth ten is a pontic carried on a bridge spanning nine to eleven. A pontic is a replacement tooth suspended between two supporting units rather than standing on an implant of its own.
Adjacent implants in the anterior maxilla compete for the same limited bone between them, and the papilla, the small triangle of gum that fills the space between two teeth, is difficult to maintain between two implants placed side by side. Spanning the gap with a pontic gives the soft tissue a better chance of looking like gum between teeth rather than a flat shelf.
The Result
Five units now span teeth seven to eleven: an implant crown, a porcelain veneer, and a three-unit bridge. The flipper is gone, and he bites on teeth anchored in his jaw rather than on an appliance resting against his palate.
The grafted bone now carries load again through the implants. An implant loads the bone in a way a denture does not, and that load helps preserve the ridge we rebuilt for this reconstruction.
Frequently Asked Questions About Bone Grafting and Front Tooth Implants
Why did the bone need grafting before implants?
The load teeth transmit into the alveolar bone is what maintains it. Once teeth are lost the ridge resorbs, quickest in the first year and slowly thereafter. Where it has resorbed below the volume an implant requires, we rebuild the bone and let it consolidate before placing anything in it.
Does a partial denture prevent bone loss?
No. A removable partial rests on the soft tissue and transfers its load to the tissue rather than into the bone, so the ridge continues to resorb underneath it. That is why a flipper that fitted well at the start needs relining as time passes.
Why three implants for four missing teeth?
We made tooth ten a pontic, a replacement tooth suspended between two supports rather than standing on its own implant. Adjacent implants in the anterior maxilla compete for the limited bone between them, and the gum papilla is difficult to maintain between two implants side by side. Spanning the gap gives the soft tissue a better result.
What is a pontic?
A replacement tooth in a bridge that has no implant or root of its own. The units on either side support it, and our ceramist shapes it to emerge from the gum as a natural tooth would.
Why was the healthy natural tooth given a veneer?
Tooth eight needed no treatment for its own sake. It sits at the midline with new restorations on either side, and leaving it untouched would have required everything around it to match one natural tooth exactly. Restoring it brings it into the same design.
Why was whitening done first?
Ceramic does not lighten. If we record a shade before whitening the natural teeth, the restorations are wrong as soon as the whitening ends, and the only remedy is to remake them.
How long does bone grafting add to treatment?
The graft has to consolidate before Dr. Mehdizadeh can place an implant into it, and that interval is what took this case to seven months rather than three or four. We cannot shorten it: placing an implant into a graft that has not consolidated risks losing both.
Will the grafted bone hold up over time?
An implant loads the bone in a way a denture does not, so the reconstruction the graft made possible also helps preserve it, provided you keep up care of the implants and the tissue around them stays healthy.
Is an implant bridge cleaned differently from natural teeth?
Yes. Conventional floss will not pass under a pontic, so cleaning runs through interdental brushes and a water flosser, together with professional recall using instruments intended for implant surfaces.
How much does bone grafting with anterior implants cost?
This case was $28,000, covering whitening, bone grafting, three implants, an implant crown, a veneer and a three-unit implant bridge. $335/month: 144 payments at 9.99% APR, on approved credit.
