Do you want teeth replaced without touching the healthy ones?
A conventional bridge requires the teeth on either side of a gap to be cut down for crowns. An implant does not involve them at all, and where the gum around the implant is shaped properly the result is difficult to pick out. Send us a photo of your smile and we will tell you what your gaps would take to close and what it would cost.
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What this case cost
$323/month
144 payments at 9.99% APR, on approved credit.
Total: $27,000 for three implants with their crowns, tissue conditioning, whitening and one replacement crown.
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Treatment Plan by Dr. Mehdizadeh
- Assessment of the three edentulous sites and of the existing crown at tooth nine.
- Three implants placed, at teeth four, five and eight.
- Healing and osseointegration.
- Tissue conditioning, contouring the gingival architecture at each site into a natural arch.
- Whitening of the natural dentition during the conditioning phase.
- Three implant crowns and one replacement crown, all shade-matched to the natural teeth.
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.
Replace three missing teeth without preparing any healthy tooth. Condition the gingival tissue at each site into a natural arch before the crowns are made. Whiten the natural dentition first, then match to it. Replace the mismatched crown at tooth nine. Complete treatment within three months.
How We 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 remodeling 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.
Frequently Asked Questions About Implant Crowns and Tissue Conditioning
What is tissue conditioning?
Provisional restorations are fitted after the implant integrates, and their contour is adjusted progressively over several weeks. Each adjustment applies gentle pressure and the gingival tissue remodels to it, so the flat collar that heals around an implant is trained into the scalloped arch a natural tooth produces.
Why does the gum shape matter more than the crown?
An implant crown 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.
What is an emergence profile?
The contour of a restoration as it rises from the implant through the gingival tissue to the visible crown. It determines the shape the tissue takes around it, which is why it is developed in provisionals before the definitive crown is made.
Why implants rather than a bridge?
A conventional bridge requires the healthy teeth on either side of a gap to be prepared for crowns. This patient asked for minimally invasive treatment, and an implant replaces a missing tooth without involving its neighbors at all.
Why was an existing crown replaced when it was sound?
It had never matched the teeth around it. Leaving it would have meant matching three new restorations to a shade that was already wrong, or accepting one obvious restoration in the middle of a result designed not to be noticed.
What makes a restoration look age-appropriate?
Restrained shade and deliberate variation. Restorations read as artificial mainly through uniformity, identical color and contour across every tooth with an unbroken gingival line. Natural dentitions are not uniform, and reproducing their small asymmetries is what lets ceramics disappear among them.
Why was whitening done during the healing phase?
Because the tissue was remodeling regardless, so the whitening cost the treatment no additional time. Ceramic does not lighten, so the natural teeth are whitened and allowed to stabilize before any shade is recorded.
How long does an implant take to integrate?
The interval depends on bone quality and on the stability achieved at placement, and it is assessed rather than assumed. In this case the whole sequence, from placement through conditioning to the final crowns, ran three months.
Do implant crowns need different cleaning?
The crown is cleaned as a tooth is, but the tissue around an implant is managed on a professional recall using instruments intended for implant surfaces. Implants do not decay, but the tissue around them can become inflamed.
How much do three implant crowns cost?
This case was $27,000, covering three implants with their crowns, tissue conditioning, whitening and one replacement crown. $323/month: 144 payments at 9.99% APR, on approved credit.
