Lateral Incisor Implant Case: A Custom Restoration for About 6 mm of Space

The upper lateral incisor is the smallest tooth in the anterior arch and one of the hardest to replace with an implant. When the adjacent roots have converged, the available mesiodistal space can be down to roughly 6 mm, the implant may not sit on the axis the crown needs, and any metal collar will show through thin gingiva. This case shows how ASD Dental Lab built the restoration for those three conditions at once — and what the treating clinician approved at each step.

Patient Situation

The patient was an adult in their thirties. The lateral incisor had never erupted; a primary tooth had kept the space open for years and was eventually lost. The gap was closed with a removable flipper for about a decade, and an adhesive bridge placed during that period debonded more than once.

Two things in the record shaped everything that followed. First, the neighbouring central incisor and canine were intact, and the patient did not want either of them prepared — that closed off the bridge route and left an implant-supported crown. Second, the patient was explicit about not spending another long stretch without a front tooth, which meant the provisional stages had to be planned as a sequence rather than left open.

The imaging showed why this was not a straightforward single crown. The ridge was narrow and the facial bone angled outward, so an implant placed along the existing bone direction would have ended up off the axis the crown required. The roots of the neighbouring teeth had converged, leaving about 6 mm of working space. The gingiva was thin. Read together, those three findings set the whole scope of the case.

The Four Obstacles and What the Clinician Asked For

How ASD Dental Lab Answered Each Requirement

1. Deriving implant position from the intended tooth form

The lab combined the CBCT data with the intraoral scan to build a virtual patient, then set up the intended lateral incisor form in that virtual patient. The implant position, depth and axis were derived backwards from where the crown needed to be, rather than following the existing bone direction.

What came out of that step: a surgical guide, a verification model, and a position report the clinician reviewed before the surgical stage — exit-point location, axis angle, insertion depth, and the shortest distance from the implant to each adjacent root.

The bone volume that can be kept on the facial aspect is the number that most affects how the tissue behaves afterwards; it is one of the planning values clinicians assess on CBCT when deciding whether a site needs augmentation before an anterior implant. The ITI consensus statement on buccal bone wall thickness sets out that relationship in detail.

2. Working inside 6 mm and keeping the access out of sight

• Proximal clearance — the clinician specified roughly 1 mm on each side for the papilla, and the crown width was built to fit within the available space.
• Channel axis — the screw channel was drawn from the implant axis, and the opening was checked to sit away from the facial surface and outside the occlusal contact.
• Channel approval — the channel position was submitted as a separate confirmation view before the design was approved, so a conflict between the channel and the crown form would surface while it was still editable. Had the two been incompatible, the options would have been put to the clinician — a revised form, a different component, or a change of retention — rather than resolved silently.

3. A metal-free margin on thin tissue

A zirconia custom abutment was used instead of a titanium base, and the crown was layered rather than milled from a single high-translucency blank, which keeps the value and the surface character closer to a natural tooth.

Shading was handled against calibrated clinical photographs with a shade guide in frame. At the abutment stage, the provisional stage and the final stage, each of them submitted a photograph for the clinician to confirm before the next piece was made.

The emergence profile was not drawn from scratch. The clinician supplied a scan of the healing abutment or the provisional contour, and the lab used it as the reference for a gradual transition out of the implant platform. The shape was split into two parts: the subcritical contour, which controls the deeper profile where the tissue meets the restoration, and the critical contour, which controls the visible gingival margin. Splitting them that way is what allows the provisional to change the tissue and the final crown to keep that result. Anterior implant esthetics rests on this kind of three-dimensional positioning and soft-tissue management, which the ITI consensus on esthetics in implant dentistry develops further.

4. A provisional sequence instead of a gap

The patient could not stay without a front tooth, so the case was built as a three-piece replacement chain, all from one digital dataset.

The provisional was designed with no contact in centric or lateral excursion so it could sit in place without interfering, and its subgingival section was shaped rather than left as a flat emergence. Each stage used the same digital dataset, so the emergence profile the provisional established was the profile the final crown inherited.

Files the Lab Needed Before Designing

Nothing above was possible until the file set arrived. For this case the lab required the CBCT data, the intraoral scan with the correct scan body, the opposing arch, a verified occlusal record, and identification of the implant system, platform, connection and CAD library — read from the packaging label or from photographs of the component. Photographs were needed for the same reason: a frontal smile view to judge the gingival line against the neighbouring teeth, intraoral occlusal views for the contact area, and a shade photograph.

ASD takes digital data from 3Shape, iTero, Medit link, SHINING 3D, DEXIS, Primescan, DS Core, PANDA and WeTransfer. Where a clinic works from its own implant library, the lab uses the clinic’s library so the components seat as intended.

Component identification is treated as a safety step, not paperwork. The interface, the channel and the seating of the restoration all depend on the right library being loaded, which is why implant systems, platforms and abutments are covered by their own regulatory performance criteria — see the FDA special controls for root-form endosseous dental implants and abutments.

Production and Inspection

The Delivered Result

Sending a Similar Case to ASD

• CBCT and any other imaging the clinician needs
• intraoral scan with the correct scan body, plus opposing arch and occlusal record
• implant brand, system, platform, diameter, connection and component reference
• packaging label or component photographs
• clinic implant-library details where a specific library is required
• frontal smile photograph, intraoral photographs and shade photograph
• scan or reference of the healing abutment, provisional or soft-tissue contour
• prescription covering material, retention, contacts, occlusion and approval points
• written confirmation for any approved component substitution
• Turnaround and tracking — a complex implant case is quoted and scheduled on 5-7 working days, measured from the day the file set is complete and the design is approved. The case can be followed through receipt, design, production, inspection and dispatch, with a tracking number sent at shipping. Transit and customs sit outside that production period.

Common Questions

Can the lab take a case where only about 6 mm of space is left?

The lab reviews narrow-space cases individually. Approval depends on the complete file: the implant position, the measured space, the component specifications and a tissue reference. A keyword alone is not enough to commit to a case.

The implant sits at an angle and the channel would come through the face. What happens?

Send the implant position and the intended crown form for review. Depending on the system and the clinician’s approval, the answer may be a revised crown form, an angled channel component, a relocated access position or a different retention method. The lab does not change a component or the retention approach without approval.

Which files are needed for a single implant crown?

The scan-body scan, opposing arch, accurate occlusal record, implant system label with platform and connection, clinical photographs, shade information, and a soft-tissue or provisional reference where available. Complete files mean fewer stops during design.

How does the soft-tissue shape carry over to the final crown?

The tissue shape is captured once — usually from the provisional or the healing abutment — and the final crown copies it. That single dataset becomes the reference contour for the critical and subcritical emergence, checked in the digital design before the crown is milled.

Who decides if a component is substituted?

The clinician. If the original component is unavailable or the budget requires an alternative, the substitution goes to the clinic for approval — verbal or written, but agreed before production. The general principles for choosing between original and compatible components are summarised in the clinical review on implant prosthetic components.

What happens when the data is unclear?

The case coordinator sends the specific problem back with a marked image of the area that needs attention. Depending on the case that means a clearer scan, a new impression, a corrected occlusal record or the missing component information. The case is not manufactured on an assumption.

Which problems get remade at the lab’s cost?

Fit, occlusion, contacts, shade and visible defects are treated as lab responsibility. A remake caused by a colour or material change requested by the clinic, or by an unclear model or scan, is handled differently. The cause is confirmed with the clinic before a remake starts, and a remake case is prioritised.