Anterior Implants with Skeletal Facial Growth

Jan 23 / Dental Online Training

DOT Study Club Recap- Check out a clip from our latest discussion!

Want to listen to the full conversation? Log in and visit your Study Club Member page to view the recording!
Last night’s DOT Study Club sparked an interesting conversation around anterior implants and skeletal facial growth, driven by a patient case that many of us can relate to.

Dr. Hartlieb shared the story about two of his female patients with congenitally missing lateral incisors.  One of these patients had implants placed to replace the missing lateral incisors when she was 19 years old, while the other patient had implants placed for tooth replacements at 21 years old.   Both patients also had veneers placed on the centrals and canines to improve the esthetics of their smiles, We have been taught that it should be safe to treat both of these patients with dental implants as they have completed their facial growth.  For the first patient (patient 'A' in the photos below), the gingival margin positions of the natural teeth and the restored dental implants appear to be consistent, without any obvious tissue height changes in a 8 year post-op photograph.  However, for the second patient (patient 'B'), there are significant and notable changes in the gingival margin positions, and the incisal edge positions of the dental implants and the restored contralateral teeth after 7 years.  Why the difference between these two female patients that are similar in age with the same treatment completed?

Dr. Hartlieb connected this clinical experience to long-term research showing that even “mature adults” can experience vertical changes between natural teeth and implant-supported crowns over time.

The group discussed how unpredictable skeletal growth can be, why implants behave differently than natural teeth, and how this uncertainty can influence treatment planning—especially in young adults. The conversation also explored alternative approaches, like single-wing bonded bridges, and why they can sometimes be a safer, more flexible option.

Patient A- Gum levels remain consistent- no skeletal growth
Patient B- Gum levels not consistent due to skeletal growth
During the conversation, Dr. Hartlieb referenced a landmark study published in the Journal of Clinical Periodontology examining long-term vertical changes of anterior maxillary teeth adjacent to single implants in both young and mature adults. This research helped reinforce the importance of long-term planning when restoring the anterior zone.

Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. A retrospective study
J P Bernard 1, J P Schatz, P Christou, U Belser, S Kiliaridis

Abstract
"Aim: To evaluate the effects of the tooth eruption process on the position of teeth adjacent to implant-borne restorations in adult patients compared to patients in their late adolescence.

Subject and methods: The sample included 28 patients divided into two groups. A "young adult" group consisting of 14 patients, aged from 15.5 to 21 years, and a "mature adult" group consisting of 14 patients, aged from 40 to 55 years. All patients presented missing anterior teeth, requiring insertion of 40 implant fixtures (16 central incisors, 12 lateral incisors, 12 canines). The implants were of the Straumann Dental Implant System, clinically and radiologically re-evaluated 1 year or more after the surgical procedure (mean interval=4.2 years). Assessment of the eruption of the adjacent teeth was performed using the implant as a stable point of reference: measurements of the different reference points were compared after implant placement and at follow-up examination.

Results: In the "young adult" group, all patients showed infra-occlusion of the implant-supported crowns: the vertical step measured on radiographs varied between 0.1 and 1.65 mm. In the "mature adult" group, all patients showed a vertical difference between the teeth adjacent to the implant-supported crown and the implant: the measured step ranged from 0.12 to 1.86 mm. No difference was found in the amount of vertical eruption between male and female patients, nor according to localization of the implant.

Conclusion: Mature adults can exhibit major vertical steps after anterior restorations with osseointegrated fixtures to the same extent as adolescents or "young adult" individuals with residuous growth potential."

(c) Blackwell Munksgaard, 2004