Front Tooth Implants in Ukraine

The front teeth (the central and lateral incisors and the canines) differ anatomically from the back teeth. The outer bone wall over an incisor root is thin, often less than 1 mm, and gets much of its blood supply from the tooth's own ligament. Once the tooth is extracted, this wall starts to resorb, so the gum contour sinks inwards in the first months after tooth loss, and the longer you wait, the more tissue has to be rebuilt.

Technically, the surgery is the same as for back teeth: a titanium implant is placed in the bone, fuses with it, and a crown is fitted on top. What differs is not the surgery but how the result is judged. For a back tooth it is enough for the implant to be stable and withstand chewing forces; at the front, what also counts is the height of the gum papilla, the symmetry of the gum margin with the neighbouring tooth, the shape and colour of the crown, and whether a grey shadow shows through thin soft tissue.

The procedure is indicated when one or more front teeth have been lost: after an injury, with a vertical root fracture, after failed root canal treatment with chronic inflammation at the root tip, or with a congenitally missing lateral incisor. An implant avoids grinding down the neighbouring teeth for a bridge, which matters here because they are usually healthy teeth that have never been treated.

In some situations the procedure is not done or is postponed. Teenagers and young people whose jaws are still growing do not have implants placed in the front of the mouth: an implant does not move with the jaw, and over time the crown ends up shorter than the neighbouring teeth. Growth ends at roughly 17–18 years in girls and 20–21 in boys, sometimes later, so until then the gap is filled with an adhesive bridge or a removable appliance. Surgery is also postponed in patients with uncontrolled diabetes or untreated periodontitis, during intravenous bisphosphonate or denosumab injection therapy, and after radiotherapy to the jaw area.

MediUkraine is a treatment search and coordination service, not a clinic. We select the clinic and a doctor with the right specialism, agree visit dates and support patients, including those travelling from abroad. Whether this treatment is possible in your case is decided by the doctor after an examination and a review of the CT scan.

Depending on timing, there are three protocols. Immediate: the implant is placed in the socket straight after the tooth is extracted, in a single visit. Early: after 4–8 weeks, when the soft tissue has healed but the bone has not yet had time to remodel significantly. Delayed: after 3–6 months, when the socket has healed completely. For front teeth, the choice depends not on convenience but on the condition of the outer bone wall on the CT scan.

Immediate placement shortens treatment and helps preserve the existing gum contour, but the requirements are strict: an intact outer wall of the socket, a thick gum biotype, no acute purulent inflammation and enough bone beyond the root tip for the implant to achieve primary stability. The implant is then placed slightly towards the palate, and the gap between it and the socket wall is filled with slowly resorbing bone graft material. If the wall is damaged, immediate placement is ruled out: the gum margin would recede within a few months, and correcting that would be harder than waiting.

The three-dimensional position of the implant matters more here than anything else. It is standard practice to leave at least 1.5–2 mm of bone on the outer side, about 1.5 mm to the root of the neighbouring tooth and no less than 3 mm between two implants; vertically, the implant is placed about 3 mm below the future gum margin. Placing it a millimetre too far outwards later leads to gum recession and a grey line at the neck, while placing it too deep makes cleaning and soft-tissue support harder. That is why surgeons more often use a surgical guide here rather than working freehand.

The gum biotype, the thickness and shape of the gum margin, determines how predictable the result is. A thin scalloped biotype with tall, pointed papillae is more easily injured and prone to recession; a thick flat biotype is more resilient and more forgiving. It is easy to assess: with a thin biotype, a periodontal probe placed in the gingival sulcus shows through the gum. If the biotype is thin, soft-tissue thickening is planned in advance rather than after recession has occurred.

Grey show-through is a complaint specific to front teeth. The titanium neck of the implant or a titanium abutment casts a cold grey shadow through thin gum tissue at the gum margin, visible when you smile. The risk is reduced in several ways: placing the implant towards the palate, a narrower platform, a zirconia abutment or a hybrid design of zirconia on a titanium base, and above all thickening of the soft tissue with a connective tissue graft from the palate. The graft is taken under local anaesthesia; the donor site heals in about two weeks and is not visible afterwards.

Bone grafting is needed more often at the front than at the back of the mouth, for purely anatomical reasons: after extraction the thin outer wall resorbs and the ridge becomes narrower. A small deficit is corrected at the same time as implant placement, with bone graft material under a membrane, a technique known as contour augmentation. A significant loss of volume is rebuilt as a separate stage 4–6 months before implantation. The material may be a xenograft, an allograft or the patient's own bone. Before surgery the doctor explains the choice and the fact that part of the graft resorbs over time, which is why the volume is slightly overbuilt.

The papilla between the crowns does not always grow back. As a rule of thumb, if the distance from the contact point of the crowns to the bone crest does not exceed 5 mm, the papilla usually fills the space; at 6–7 mm it fills it only partly, and a dark triangle remains between the crowns. The papilla between two neighbouring implants is lower than between an implant and a natural tooth, so two missing incisors in a row are a harder task than one. In that situation it is sometimes better to place one implant and restore both teeth with a cantilever bridge on it.

The soft-tissue profile is shaped after integration. First a healing abutment is fitted: a cylindrical cap that opens a channel through the gum for the future crown. But a round healing abutment creates a round opening, while the neck of an incisor is triangular in cross-section, so for front teeth it is only an intermediate step. Next a temporary crown is made and, over several adjustments, gives the soft tissue the required emergence profile. The temporary crown is kept out of the bite so that it takes no load when the teeth close or the jaw moves sideways. The gum takes 2–3 months to mature, after which its shape is transferred to the laboratory with a custom impression coping: a standard coping would destroy the contour that has already been shaped.

The permanent crown is made of lithium disilicate on a titanium base or of zirconia with a ceramic veneer; both transmit light much as enamel does. Screw retention is preferable: with cement, the excess has to be cleared from under the gum, and residual cement is a common cause of inflammation around implants. Screw retention is only possible when the access channel emerges on the palatal surface, which again depends on implant position: one more reason to plan with a guide.

The last thing to assess before starting is the smile line. If the gum does not show when you smile, a slight asymmetry of the gum margin will go unnoticed. With a high smile line, where the gum is fully visible, the result has to meet a higher standard and more preparation is needed: soft-tissue grafting and longer shaping with a temporary crown are added to the plan more often. Where bone and soft-tissue loss is significant, it is more honest to discuss a screw-retained prosthesis with gum-coloured ceramic or a bridge, which mask the tissue defect where surgical reconstruction is unrealistic. Only a doctor can predict the result in an individual case, after an examination and a review of the CT scan.

For the first two or three days there is swelling, sometimes with bruising on the lip; this is a normal tissue response, not a complication. The doctor prescribes painkillers, cold compresses on the first day, rinses or a gel for the soft tissue and, where indicated, an antibiotic. Eat soft, warm food during this period; do not brush the surgical site, but care for it as the doctor has shown you.

Stitches are removed after 7–10 days, when the doctor also checks how the gum is healing. Avoid putting load on the temporary restoration during this period: do not bite with the front teeth, cut hard food with a knife and eat apples or bread in small pieces. If a graft was taken from the palate, the donor site can be tender for about two weeks, and the doctor often makes a protective plate for that time.

Next comes osseointegration, the fusion of the implant with the bone. In the lower jaw it usually takes 3–4 months, in the upper 4–6, and if bone grafting was done at the same time, the period is longer. Before the prosthetic stage a follow-up X-ray is taken and the stability of the implant is checked; there is no point rushing, because early loading is one of the reasons implants fail to integrate.

Shaping the gum takes another 2–3 months. The temporary crown is adjusted several times during this period, gradually changing the emergence profile, and each time the soft tissue needs weeks to adapt. Patients often feel these visits drag things out, but this is the stage that decides whether the gum margin will match the neighbouring tooth.

After the permanent crown is fitted, the soft tissue still changes: in the first year the gum margin usually recedes by about 1 mm, after which it stabilises. So the final result is assessed at around 12 months, by comparing photographs taken under the same conditions, not by how it feels in the first week.

There is also a long-term effect worth knowing about in advance. Natural teeth slowly continue to erupt throughout life, while an implant stays where it is, so after 10–20 years the crown on it may end up slightly shorter than its neighbours. This is more noticeable in patients who were treated at a young age. This can be corrected by remaking the crown, but the crown should not be thought of as permanent. Check-ups every six months and an annual follow-up X-ray help catch changes early.