A broken upper central: immediate implant and a veneer, stable after five years
The patient came with a broken upper central incisor. We placed an implant the same day and used her own tooth as a temporary, then built up bone and gum in stages, and closed the gap with an implant crown and a veneer on the neighbouring central. Five years later, bone and soft tissue are stable.
From the early days
This is one of the cases I always remember. Six years ago a patient came to me with a broken upper central incisor.
On the same day
- We extracted the broken tooth and placed an immediate implant.
- We used the patient's own tooth as a temporary bridge bonded to the neighbouring teeth, so she never left the clinic with a gap in her smile.
- In the same visit, we placed an implant in the upper premolar with bone grafting and a membrane.
Building bone and gum in stages
After healing, we grafted soft tissue around the front implant and widened the gum at the premolar, then shaped the gum with provisional crowns until it took a natural form.
The final smile
We tried the design in the mouth first (mock-up), then closed the gap between the front teeth with an implant crown and an e.max veneer on the neighbouring central, on a zirconia abutment so no metal shows under the gum.
Five years later
Bone is stable, soft tissue is stable, and the two centrals match naturally. Thank God, the result keeps getting better with time.
Clinical details for dentists
1 Before: fractured upper central 
2 First day 
3 CBCT before surgery 
4 Atraumatic extraction: root out in one piece 
5 Immediate implant placement 
6 Customized healing abutment 
7 Maryland bridge using the patient's own crown 
8 Upper premolar site 
9 Premolar: bone graft and membrane, sutured 
10 Second stage: ready for connective tissue graft 
11 Soft-tissue volume after grafting 
12 Provisional phase 
13 Direct mock-up 
14 Veneer preparation on the contralateral central 
15 Ti-base with zirconia abutment 
16 Delivery: implant crown and e.max veneer 
17 Short recall 
18 Radiograph: premolar implant 
19 Radiograph: central implant 20 5-year follow-up
Case summary
Fractured upper central incisor (non-restorable). Same visit: implant in the upper first premolar site with bone graft and membrane for buccal bone development.
Protocol
- Immediate implant placement with a customized healing abutment.
- Maryland bridge using the patient's own natural crown during healing.
- Upper premolar: immediate implant, bone graft + membrane.
- Second stage: connective tissue graft for the central; apically positioned flap at the premolar to widen keratinized tissue.
- Soft-tissue conditioning with provisional crowns at both sites.
- Diastema closure: e.max veneer on the contralateral central; implant crown on a zirconia hybrid abutment (Ti-base) for colour matching and no metal show-through.
5-year outcome
- Bone width stable.
- Soft tissue stable.
- Natural matching between the implant crown and the veneered central.
Take-home message
Follow the protocol step by step, respect the soft tissue, and the result improves with time.
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