Age / build: Mid-thirties, slim face, thin lip. Enamel on the neighbouring #9 was translucent at the incisal third, with a slightly chalky value in the body. On the cross-polar photo she sent in, the hue read A2 at the cervical, drifting to a cooler, more opalescent edge.
Why the tooth came out: Fourteen years earlier, trauma. Root canal, post-and-core, PFM crown. Held fine until last year, when the patient came in with a sinus tract above #8 and a sense that the crown "moved a little when she chewed on the front." Imaging showed a vertical root fracture tracking apically from the post. The tooth wasn't retainable.
What the patient herself said: She teaches secondary school. In her words, "I can't be stood in front of a class with a gap, and I can't be the one with a weird-looking tooth either." She'd been reading online about dental implant front tooth temporary options and had a question we hear a lot: "Can I eat a sandwich with it in." The dentist's answer, which he wanted us to echo rather than contradict, was "no, you can't — and the part we're making is the opposite of a flipper. It stays in, you don't bite with it, and in four to six months it comes off and the real one goes on."
The adjacent lateral (#7) and the opposing central (#9) were both natural and unrestored. That ruled a thing in and a thing out: shade target is enamel on #9, not a ceramic, and the design couldn't borrow a shape from an existing crown — we'd have to mirror #9.
What the dentist asked for
He sent the scan file, two shade photos (one cross-polar, one ambient with the shade tab in frame), a short bite record, a profile photo for lip support, and a note. Everything landed in one upload at 10:48 pm his time; our case coordinator picked it up the next morning. The note was six lines, numbered, and every line carried a design consequence.
1. Screw-retained provisional on a custom titanium base. "No cement sub-gingival. Period." → We'd mill the body in PMMA and bond it to a custom titanium base drawn from the implant maker's library for his platform. No cement line at or below the tissue margin.
2. Access channel in the cingulum, not through the labial. "Angle correct through the abutment if you have to; I don't want the hole on the face." → Angulation handled in CAD at the abutment layer, channel exiting the lingual third of the cingulum. Verified against the opposing arch so the channel wouldn't sit in protrusive contact.
3. Keep it out of occlusion. Everywhere. "No contact in max intercuspation. No contact in protrusive. No contact on canine guidance either — I'll check." → Articulated against the bite record. About 150 microns of clearance in intercuspation on the lingual, zero in protrusive, verified by eye on the model.
4. Labial contour conservative at first insertion. "I'd rather add resin at week 1 than grind yours back. Draw the labial under-full by 10–15% and leave a bondable surface." → First-pass contour drawn at roughly 85% of the mirrored #9 profile from the labial collar to the free margin. Surface finished bondable at the two expected add-points, either side of the long axis.
5. Cervical collar flat-concave. "0.5 mm sub-gingival on the labial, flush interproximally. No bulge above the platform." → Sub-gingival profile drawn flat, with a slight concavity about 1 mm above the platform, taking the collar from platform diameter up to a cervical cross-section about 15% narrower than the final crown target. The papillary side of the collar kept short, to let the papilla toward #9 grow onto it rather than get pushed by it.
6. Match the cervical third to #9. "Everything above the margin is bonus. The gum has to look right." → Shade work targeted on the cervical third first, body second, incisal third accepted as "close enough for a provisional," with a note to refine on the final E.max or layered zirconia.
What he didn't ask us to decide — and we didn't — included anything on the surgical side. We don't call insertion torque, we don't call ISQ, we don't choose a graft material, and we don't set the torque on his screw (he reads that off the implant maker's instruction leaflet). Our line stops at the design file and the finished part. His starts at the chair.
The technical problem the brief put on the bench
Three forces pulled against each other on the design desk:
Pulling toward | Pulling against | What had to give |
|---|---|---|
A labial contour that mirrors #9 (aesthetics) | A labial plate at 1 mm and a thin biotype that can't take pressure (biology) | First-pass labial drawn under-full; aesthetics made up optically with shade |
A papilla toward #9 that already sat 2 mm short (aesthetics) | A collar that must not push on the tissue (biology) | Flat-concave sub-gingival on the papillary side; papilla left to grow onto the restoration |
A material that can be re-shaped at the chair twice (workflow) | A material that polishes to a surface that resists plaque for four to six months (biology) | Milled PMMA on a titanium base; add-points keyed into the labial under the cervical third |
Read the three rows together and that's where the design came from. Nothing we did on this dental implant front tooth temporary was material-first — it was all biology-first, with material and shape bent to fit.
Our fabrication process, step by step on this file
Every step below ran inside our own shop. No outsourcing to a sub-lab. One file, one anterior desk, one QC chain.
Step 1 — Case intake and pre-flight (same day)
The scan body in the file was checked against the implant platform photograph the dentist attached. The library match came back clean on the first pass. The coordinator ran our standard anterior checklist:
- Scan body visible, no distortion at the margin — ✓
- Opposing arch and bite record included — ✓
- Shade photos with the shade tab in frame, one cross-polar — ✓
- Soft-tissue reference around the healing abutment, so we could read the gingival architecture at second-stage — ✓
- Implant platform code logged against the system library — ✓
- A written target for cervical margin, occlusion and add-strategy — ✓
Nothing missing. If any one of those had been off, we'd have paused and asked. A front tooth temporary built on an incomplete file is where the cheap failures live.
Step 2 — CAD design on the senior anterior desk
Anterior single-units don't go to a general queue here. Our rule is that single front-tooth implant provisionals go to a technician with a decade or more at the bench. On this one the designer:
- Pulled the custom titanium base from the implant library for the dentist's platform.
- Drew the screw channel exit through the cingulum, with the angulation taken up at the abutment layer so the restoration's labial stayed uninterrupted.
- Mirrored #9 across the midline for the gross tooth form.
- Scaled the labial contour down to roughly 85% of mirrored #9, from the cervical collar to the free margin. On a thin-plate case this is the single most important move — it's what gives the dentist room to add across two reviews instead of cutting back once.
- Drew the collar flat-concave on the labial, flat interproximally, with the papillary side of the collar deliberately short of the mirror target. The papilla should rest against the restoration, not be pushed by it.
- Opened the proximal embrasures wider than a definitive crown would be. This part lives under an interdental brush twice a day for four months, and plaque at the papilla line is the fastest way to lose the tissue we were trying to save.
- Routed the finish line so the margin would be legible on an impression later. Transfer of the sub-gingival profile to the final crown doesn't happen by accident — it has to be visible on the final impression, which means the provisional's sub-gingival collar has to be impression-readable from day one.
The design file went to the dentist as a 3D preview before we cut anything. He came back inside the business day with two notes — ease the papillary collar on the mesial a shade more, and bring the incisal edge in by about 0.3 mm. Both edits took twenty minutes. Approval locked after the second preview.
Step 3 — Model print, Ti-base fit, PMMA milling
The physical model was printed from the approved design file with the implant analog seated. The titanium base was placed into the analog and checked by eye and probe for rock and gap — none, screw torqued to the implant system's own number (we don't substitute). The PMMA sleeve was milled from a pre-polymerized block on the five-axis mill.
Milling the sleeve from a solid block rather than printing it mattered here for two reasons on an anterior temporary:
- Density is uniform. Printed resin has a layer orientation, and under a thin labial section on a part that's going to see tongue pressure and the occasional unintended bite for four months, a printed layer line can read as a weak axis. Milled PMMA doesn't have that.
- The surface polishes to a glass. On a part that lives against gingiva for months, polish is plaque control. A rougher surface — printed resin's weak spot — reads back as a redder margin at the one-week review.
The sleeve was bonded to the titanium base with the recommended surface treatment, the margin finished and polished under 10× magnification, and the sub-gingival collar finished to the drawn geometry — flat-concave on the labial, with the designed concavity checked against the model using a radius gauge.
Step 4 — Shade work on the cervical third
The brief said "match the cervical third to #9." That's where we spent the time. On a layered final crown we'd layer across all three thirds; on a PMMA dental implant front tooth temporary we'd match the one that shows at the margin and accept the rest.
Our anterior lead read the two photos in sequence. Cross-polar first, to pull a hue read free of reflections. Ambient second, with the shade tab in frame, to confirm value and chroma. The stump photo told us whether the titanium base would shadow through — on a thin biotype at the cervical, a dark substructure can bleed grey into the gum. Our call: light tissue-coloured masking at the collar, body shade biased slightly warm, incisal translucency accepted as within a provisional's window. All three decisions were logged in the file, so the final E.max or layered zirconia could start from the same reference next spring.
Step 5 — QC before dispatch
Standard anterior pre-ship pass:
- Marginal fit against the model analog — no visible gap under 10×
- Internal seating — no rock, no high spots on the intaglio
- Interproximal contacts — light on both sides, holds floss with resistance
- Screw access patency — driver seats cleanly, no interference with the restoration body
- No cracks, no voids, no chipping at the margin
- Profile symmetry read against mirrored #9 on the model — within the dentist's second-preview edits
- Surface polish graded against our anterior reference block
Everything cleared. The part shipped with the titanium screw at the maker's spec, two bondable add-point keys for the dentist's chairside work at week 1 and week 4, and a copy of the design file for the final-crown handoff.
Door-to-door delivery to his clinic landed inside the window we'd quoted for an anterior single-unit.
Design goals of the finished part
Goal (from the dentist's brief) | How the part delivers it |
|---|---|
No pressure on a 1 mm labial plate | Labial contour at 85% of mirrored #9; collar flat-concave |
Papilla toward #9 grows onto the restoration | Papillary side of the collar short of mirror; proximal embrasures opened |
No sub-gingival cement | Screw-retained; channel exits lingual cingulum |
Out of occlusion, everywhere | ~150 µm clearance in intercuspation; zero in protrusive and canine guidance |
Addable at the chair twice | Milled PMMA body; two bondable add-points keyed into the labial |
Sub-gingival profile transferable to the final crown | Collar drawn impression-readable; design file retained for the final-impression handoff |
After the try-in
The part was tracked across insertion and two review visits in the five weeks that followed.
Dentist feedback. Seated on the first try, no cement interference and no grey shadow at the margin. Occlusion checked clear in intercuspation, in protrusive and on canine guidance. At the one-week visit, about 0.4 mm of labial resin was added at the cervical to bring the contour up toward mirrored #9, bonded cleanly to the designed add-points, and the margin stayed white-free. By four weeks the papilla toward #9 was level with the contralateral side, there was no bleeding on probing, and the dentist confirmed no recession and no shrinkage. His summary: the case worked because the provisional was built deliberately under-full and designed to be corrected twice while the tissue took its shape — not fought with at the chair.
Patient feedback. The part did not read as "a temporary" to her — she described it as her own tooth that she was being careful with. The gum line held where it was from day one, which was her main worry. Shade stayed stable through daily coffee. She was eating soft food, not biting with it, and wearing it all day without noticing it.
The sub-gingival profile recorded in the design file is being carried forward to the final E.max; the final crown is scheduled after osseointegration is confirmed on radiograph.
Working with us on a case like this
What we need from you. An intraoral scan with the scan body seated, implant platform information, opposing arch and bite record, two shade photos (one cross-polar if you have it) with a shade tab in frame, a soft-tissue reference around the healing abutment, and a short written note on cervical margin position, occlusion target, and any add-on strategy you're planning. If something's missing we'll ask before we open the file.
What you'll get back. A 3D design preview for approval before anything is cut, and a written spec of the design points — margin position, screw access path, cervical profile, shade read.
How we work. Design, model print, milling, titanium base bonding, polishing and QC all happen in our own facilities in Shenzhen and Huizhou. We don't send cases out to third-party labs. Most mainstream implant systems and platforms are supported — send the platform code with the case and we'll confirm the library match before anything ships. Anterior single-tooth implant work goes to technicians with a decade or more at the bench.
About this case profile
This page describes a single anonymized case profile. The clinical situation — upper central incisor, thin labial plate after grafting, medium-high smile line, screw-retained PMMA provisional on a custom titanium base — reflects the kind of anterior implant work Istar handles routinely, and the design decisions, materials, team structure, QC steps, and clinical correspondence described above are drawn from our internal workflow. Patient identifiers, clinic name, country and specific dates are withheld.
Where clinical thresholds are cited — buccal plate thickness, insertion torque, papilla preservation rate, satisfaction scores, timing — the source is linked inline so you can verify the claim at its origin.
Sources
- Hamilton et al., Clinical Oral Implants Research, 2023 — selection criteria systematic review and meta-analysis; immediate-provisionalization threshold of insertion torque ≥35 N·cm and/or ISQ ≥70. <a href="https://onlinelibrary.wiley.com/journal/16000501" rel="nofollow">Clinical Oral Implants Research</a>
- Donker et al., Journal of Clinical Periodontology, 2024 — 10-year RCT, immediate vs delayed provisionalization in the anterior maxilla; implant survival 100% vs 100%, restoration survival 88.9% vs 87.5%, satisfaction 8.4 vs 8.6/10. <a href="https://onlinelibrary.wiley.com/journal/1600051X" rel="nofollow">Journal of Clinical Periodontology</a>
- Soft and hard tissue changes following immediate implant placement — systematic review, Evidence-Based Dentistry (Nature), 2024. Papilla preservation attributable to interproximal bone crest, tooth-implant distance, implant position, phenotype, and provisional contour. <a href="https://doi.org/10.1038/s41432-024-01091-7" rel="nofollow">Nature</a>
- Immediate provisionalization of single extraction-site implants, prospective study — 78% complete papilla preservation at one year (single study, not a general promise). <a href="https://pubmed.ncbi.nlm.nih.gov/20224830/" rel="nofollow">PubMed</a>
- Immediate implant placement and provisionalization in the esthetic zone, 6.5-year follow-up. <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8457954/" rel="nofollow">PMC</a>
- Optimizing implant placement timing and loading protocols. <a href="https://www.mdpi.com/2077-0383/14/5/1442" rel="nofollow">MDPI JCM</a>