message board Patient With Implant Who Hates Her Smile Townies debate treatment options for a patient with a high smile line and uneven gingival margins dhmjdds Member Since: 11/16/04 Post: 1 of 16 This is a 25-year-old woman who recently consulted with me about improving her smile. Her history is (very) significant for a fall a couple years ago in which UR2 was fractured subgingivally and could not be saved. She had an implant placed (I believe an immediate one) and a crown, as per normal. Now, she "hates" her smile. Mostly she hates her implant. But nothing is terrible about either the implant or its crown-it's her high smile line that exposes the uneven gingival margins. Can anything be done to help her out here? Besides tucking in the UL2 and flaring the U1s slightly, I don't even see anything we can do with that implant there. ■ 7/10/2020 Fenrisúlfr Member Since: 02/25/09 Post: 2 of 16 dhmjdds Member Since: 11/16/04 Post: 3 of 16 Fenrisúlfr Member Since: 02/25/09 Post: 4 of 16 Can you post the ceph? Thanks. ■ 7/10/2020 I don't take them at the initial patient visit, sorry. ■ 7/10/2020 No worries. Tough to see what she's unhappy about. Would help to know if the excessive display is due to VME vs. short upper lip or excessive animation, etc. ■ 7/10/2020 odell060 Member Since: 11/19/11 Post: 5 of 16 Looks like a fairly significant bony defect of the buccal bone near the implant. Also the pics are a bit fuzzy, but the gingiva near the implant looks very inflamed. I would be thinking possible excess cement subgingival. If the other ortho concerns are not an issue to her, perhaps a visit with a periodontist or prostho may be an idea. A new screw-retained crown on the implant (I think the match of the crown could use improvement as well) may be exactly what she is looking for. ■ 7/10/2020 18 SEPTEMBER 2020 // orthotown.com OT0920_MB1_Implant_AG.indd 18 8/26/20 1:13 PMhttp://www.orthotown.com