Kristine Aadland Here is a tough implant case that walked through my door a few days ago for impressions. He was referred to me by the oral surgeon, post placement.
This is a young man who has never had a filling, but had got into an unfortunate accident with the handlebars of his bike and the bike obviously won. He went through root canal therapy on #9 and #10, crowns, retreatments, extractions and finally implants. He was ready to be done and have teeth and the surgeon told him I could do it in a day 
.
So this is what I see...
1. two implants next to each other in the anterior that are not easy to restore
2. Not awesome tissue or chance for a great papillae between #9 and #10
3. Distal inclination of #8 and an overlap of #7/8
I have the discussion with the patient:
Do you want ortho to straighten up your central?- "no"
Do you want to add composite on that tooth to make it appear straight?- "not really "
Did you have a gap between your front teeth before or a space?- "no, I want them to touch"
Would you be interested in another gum graft if possible?- "I really just want teeth that don't come out at night"
So here is what I came up with. I could not split this case because there was not enough room unless I put the margins on the abutments up pretty far above the gingival level. These are screw retained.
I was pretty excited about the staining and glazing. I used an A1 LT and carried the shade 1 down towards the incisal to match his other teeth. Here is what I am struggling with:
I don't love the midline slanting and wish I would have just placed composite there instead. The reflection on #9 tells me that I need to flatten that part of the facial wall just slightly and polish it back up to mirror the other central. Last but not least, I don't love the embrasure space between #9 and #10 but I am not sure if that is possible to fix.
Would a graft work here? Pink porcelain might have been an option for an illusion but super tricky, especially without a model. The other option I am thinking of is Anaxdent Anaxgum paste. I have never used it but saw it on another post... Has anyone tried it?
I am hoping to accomplish this:
but how possible is that?
At the end of the day he was happy to have teeth. I am just curious on what other people would have done in this case. I don't think temporaries would have done too much because there isn't a lot of tissue to move around. The implants are shallow. I'm leaning towards trying the anaxgum because I wouldn't have to remove or refire the implant crowns but I would love other ideas too.
Thanks!
