Does it feel like too many things are wrong at once?
A gap, an uneven gum line and chipped edges are three separate problems with three separate causes, and each one has to be treated in an order that sets up the next. Being able to see that order is most of what makes a case like this manageable. Send us a photo of your smile and we will tell you what is going on and what it would cost to put right.
- A call within two hours during office hours.
- A written cost from us, before you commit to anything.
- No obligation. Many patients take weeks to decide. That is normal.
What this case cost
$562/month
144 payments at 9.99% APR, on approved credit.
Total: $47,000 for the extraction, one implant, aesthetic crown lengthening, one implant crown and nineteen porcelain veneers.
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Treatment Plan by Dr. Mehdizadeh
- Assessment of the impacted canine, the gingival heights and the worn incisal edges.
- Extraction of the impacted canine at tooth six.
- One implant placed at tooth six.
- Aesthetic crown lengthening to level the gingival architecture across the upper arch.
- Healing and osseointegration.
- One implant crown at tooth six.
- Nineteen porcelain veneers in total: nine across the upper arch and ten in the lower.
The Patient's Journey
This patient had an impacted upper canine, a tooth that had formed in the bone but never erupted into the arch. The space where it should have been read to everyone who looked at her as a missing tooth. Around that gap sat an uneven gingival line and a set of chipped incisal edges, so there were three separate problems visible in the same photograph.
What she said was that she wanted a nice smile, and that she felt overwhelmed by how many separate things appeared to be wrong with the one she had. She wanted somewhere that would deal with all of it, rather than sending her to three offices for three parts of it.
Understanding the Challenge
Her canine lay in the bone in a position from which it could not erupt, so the options were to bring it into the arch orthodontically or to remove it. Orthodontic exposure and traction is the preferred route in adolescence. In an adult whose skeletal growth is complete and whose arch has closed around the space, both the timescale and the predictability deteriorate considerably.
The gingival asymmetry was a separate finding with a separate cause. It would have persisted through any amount of restorative work. People judge gum heights by comparison rather than by measurement, so they notice when the margin over one tooth sits at a different level from its counterpart.
The chipped incisal edges were the least significant of the three clinically, but they carried diagnostic information. Enamel does not fracture without an opposing surface loading it, so the chipping indicated that the incisal relationship between the arches needed attention alongside the appearance.
Remove the impacted canine and replace it in the arch. Level the gingival architecture across the upper anterior teeth. Restore the chipped incisal edges. Establish an occlusion in which the opposing teeth do not load the restored edges destructively. Address all of it in one plan rather than three.
How We Approached Treatment
Dr. Mehdizadeh extracted the impacted canine and placed an implant at tooth six, which converts an unpredictable adult orthodontic problem into a restorative one with a defined timescale. The canine position matters more than most. It occupies the corner of the arch, where the smile turns from the anterior teeth toward the posterior segments, and a gap there flattens the entire line.
He then performed aesthetic crown lengthening across the upper anterior teeth, removing gum tissue and recontouring the underlying bone so that the margins sat at the heights the planned restorations required. Carrying out the surgery before the veneers lets us design each restoration to a known gingival position. Reversing the order means fabricating ceramics to accommodate tissue that has not settled.
Nineteen veneers followed: we placed nine across the upper arch alongside the implant crown at tooth six, and ten in the lower arch. The lower veneers are there for color and for the occlusion. Restored upper teeth against an untreated lower arch diverge in color within a year or two, because natural enamel takes up stain and ceramic does not. The edges that had been chipping also needed an opposing arch designed to stop chipping them.
The Result After Five Months
An implant crown closes the gap at the canine, and the gingival line runs level across the upper anterior teeth. We restored the incisal edges in a material considerably harder than the enamel that had been fracturing.
We treated all three problems inside a single plan, in a deliberate order. The surgery preceded the ceramics because our laboratory had to make them to a settled gingival position, and we treated both arches together because the fracturing edges needed their opposing surfaces designed alongside them.
Frequently Asked Questions About Impacted Canines and Gum Lifts
What is an impacted canine?
A canine that formed in the bone but never erupted into the arch. It is present and visible on imaging, lying in a position from which it cannot come through on its own, and the space where it should be reads as a missing tooth.
Why extract an impacted canine rather than bring it into the arch?
Orthodontic exposure and traction is the preferred route in adolescence. In an adult whose bone has matured and whose arch has closed around the space, the treatment time is long and the outcome considerably less predictable. Extraction and an implant converts it into a restorative problem with a known timescale.
Why does a missing canine matter more than another missing tooth?
It sits at the corner of the arch, where the smile turns from the front teeth toward the back. A gap in that position flattens the line of the whole smile rather than leaving a hole in the middle of it.
What is aesthetic crown lengthening?
We remove gum tissue and recontour the bone beneath it so that the gum margins sit at planned heights. The procedure corrects an uneven gum line and sets the proportions we then design the restorations to.
Why is the gum lift done before the veneers?
So that we design each restoration to a known gingival position rather than to whatever the tissue happens to be doing on the day. If we placed the veneers first and the margin later moved, we would have to remake them.
Why treat the lower arch as well?
For color and for the bite. Restored upper teeth against an untreated lower arch diverge in color within a year or two, and edges that have been chipping need the opposing arch designed so that it stops loading them destructively.
Why were the front teeth chipping?
Edges do not chip without something opposing them. Chipping is a sign that the incisal relationship between the arches is loading the edges in a way they cannot tolerate, which is why we addressed the bite rather than only the appearance.
Can all of this be done in one office?
At most practices a case like this means a referral to an oral surgeon for the extraction and implant, a periodontist for the gum lift, and a restorative dentist for the ceramics. Here we planned and carried out the surgical and restorative phases together, which is what removes the coordination delays between them.
How long does treatment like this take?
This case ran five months. Osseointegration and healing after the crown lengthening account for most of that period, and we cannot shorten either.
How much does this kind of treatment cost?
This case was $47,000, covering the extraction, one implant, aesthetic crown lengthening, one implant crown and nineteen porcelain veneers. $562/month: 144 payments at 9.99% APR, on approved credit.
