New Teeth Without Touching the Healthy Ones

The Patient's Journey

This patient had lost three teeth and wanted them replaced without disturbing anything that was still healthy. She asked for minimally invasive dentistry in those words, and she was equally specific about the appearance she wanted: natural, and appropriate to her age. That second requirement shaped the case as much as the first.

She also carried an older crown at tooth nine that had never matched the teeth around it. It was sound, but it read as a restoration from across a room, and leaving it in place would have meant matching three new crowns to a shade that was already wrong.

Understanding the Challenge

An implant crown is judged almost entirely on the tissue it emerges from. A restoration can be correct in shade, contour and translucency and still announce itself. If the gingival margin around it sits flat where the neighboring teeth are scalloped, the eye registers that discrepancy before it registers color.

Natural gingival architecture is not level. It rises to a peak between adjacent teeth, forming the interdental papilla, and it scallops around each tooth at a height determined by the shape of the root beneath it. An implant is a cylinder, and the tissue healing around a cylinder assumes a cylindrical form unless it is deliberately shaped into something else.

Her request for an age-appropriate result pointed in the same direction. Restorations that read as artificial usually do so through uniformity: identical shade across every tooth, identical contour, an unbroken gingival line. Natural dentitions are not uniform, and reproducing their small asymmetries is what allows a restoration to disappear among them.

How Dr. Mehdizadeh Approached Treatment

Three implants were placed, at teeth four, five and eight, and left to osseointegrate. No adjacent tooth was prepared at any stage. That is what she had asked for, and it is what an implant makes possible: a conventional bridge would have required the healthy teeth on either side of each gap to be cut down for crowns.

Tissue conditioning followed integration. Provisional restorations were fitted and their emergence profile adjusted progressively over several weeks. Emergence profile means the contour of a restoration as it rises from the implant through the gingival tissue. Each adjustment applies gentle pressure, the tissue remodels to it, and the flat collar that heals around an implant is gradually trained into the scalloped arch a natural tooth produces.

Whitening was carried out during that same phase, which cost the case no additional time because the tissue was remodelling regardless. The natural teeth were lightened and allowed to stabilize, and the shade for all four restorations was recorded afterwards, against the finished color of her own teeth.

Four crowns were then fabricated: three on the implants at four, five and eight, and one replacing the mismatched restoration at tooth nine. They were made together and shade-matched individually. The small variations in translucency and surface character were kept deliberately, because adjacent natural teeth are never identical to one another.

The Result After Three Months

Four crowns sit in a complete arch, and the gingival margins around the three implants follow the same scalloped line as the tissue around her natural teeth. That line is the work of the conditioning phase rather than of the ceramics.

No healthy tooth was prepared for any of it. The teeth adjacent to each implant are exactly as they were, which was the requirement she arrived with, and the restorations are lighter than her teeth had been only because her teeth were whitened first.