AACD Website Blog Clinical Insights Replacing a Missi...

Replacing a Missing Tooth in the Esthetic Zone (Without the struggle, squirm, and sweat)

June 6, 2016 by AACD Executive Office

By Elizabeth M. Bakeman, DDS, FAACD


Seamlessly replacing a missing tooth in the esthetic zone—disguising the replacement tooth so that it looks like a “real” tooth—is a formidable challenge for even the most accomplished dentist/ceramist team. So it’s no surprise that this is one of the AACD Accreditation submissions (aka, Case Type III) that causes many members in the process of Accreditation to struggle, squirm and sweat. But it doesn’t need to be that way. It’s time to unlock the mystery and master the keys to success!


Key #1: It's About Selection

When it comes to buying a house, you have heard the phrase, “Location, location, location.” And when it comes to missing tooth situations that have the best opportunity for creating optimal results, the three aspects that matter most are, “Case selection, case selection, case selection.”  Case selection, by far, is the most important influencer to consider. There are case selection factors that lend themselves to a favorable outcome and factors that lend themselves to an unfavorable outcome. It is important to learn which are which. It should be no surprise that you want a case that has an abundance of favorable factors. Mastering your understanding of case selection is the first and most important key in the process.    


Key #2: It’s About Soft Tissue Management

Choosing a case that lends itself to a favorable outcome is a great start. However, it doesn’t mean that all lights are green. Many times we have to move an unfavorable factor in a favorable direction and that often means altering, manipulating, and managing gingival architecture. Think about it: You don’t see a Michelangelo in a shoddy frame! The restorative dentist must acquire the soft tissue management skills or learn to direct the specialist, but either way he or she must understand what is possible and push to achieve excellent outcomes. The fabulous piece in all this is that learning to manage soft tissue architecture is doable, predictable, and puts a magnificent frame on the dentistry. Mastering tissue architecture is your second key.

Key #3: It’s About Exceptionally Executed Ceramics

The prosthetic elements must disappear within the framework of the smile. Sometimes that means blending porcelain with natural teeth and sometimes that means blending porcelain with porcelain. No matter how you slice it, the end result should have symmetry, harmony, and the replacement tooth should smoothly and effortlessly blend into its surroundings. By honing diagnostic and treatment planning skills, ramping up laboratory communication and pushing expectations regarding the quality of the ceramics themselves we can achieve results that exceed our patient’s expectations. The third key is exceptionally executed ceramic elements. 


“Thanks for teaching such a great class at AACD.  I’ve never felt more prepared to tackle Case Type III! This was the first time I’ve taken a class from you but it won’t be the last!”       

~Dr. Tom Hadley, Nashville, Tennessee after taking Dr. Bakeman's course "Replacing a Missing Tooth in the Esthetic Zone -- Focus on AACD Accreditation Case Type III" at the 32nd Annual AACD Scientific Session.

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