Published in International Journal of Prosthodontics and Restorative Dentistry
A consensus report from the Brånemark Osseointegration Centre India, co-authored by Dr. B. Srinivas Rao, establishing clinical guidelines for replacing a single missing anterior tooth with a dental implant — where aesthetics and precision matter most.
Published in International Journal of Prosthodontics and Restorative Dentistry — March 2020. Co-authored by Ramesh Chowdhary, Sunil Kumar Mishra, Manish K Singh, Dr. B. Srinivas Rao, and others from the Brånemark Osseointegration Centre India.
Losing a single front tooth is one of the most visible and emotionally distressing dental problems a person can experience. Unlike a missing back tooth that can go unnoticed, a missing front tooth affects your smile, your confidence, and how people perceive you in every social and professional interaction.
While a dental implant is widely considered the best solution for replacing a single missing tooth, the aesthetic zone — the front of the mouth — is the most demanding area in all of implant dentistry. The margin for error is essentially zero. The implant must be placed at precisely the right depth, angle, and three-dimensional position to ensure the final crown looks completely natural, emerges from the gum at the correct contour, and matches the adjacent teeth in colour, shape, and proportion.
This consensus report was developed by the team at the Brånemark Osseointegration Centre India — the Indian chapter of the globally renowned Brånemark Centre founded by Professor Per-Ingvar Brånemark, the father of modern implant dentistry. Dr. Srinivas, as a Fellow and Diplomate of the Brånemark Centre, contributed to establishing these clinical guidelines.
* Thin bone and gum tissue: The bone in the front of the upper jaw is naturally thinner than in the back. The overlying gum tissue is also thinner and more translucent, meaning even a slight misalignment or a grey shadow from the implant underneath can become visible. * Gum architecture: A natural-looking front tooth has a scalloped gum line with a pointed papilla (the small triangle of gum tissue) between adjacent teeth. Recreating this soft tissue architecture around an implant requires meticulous surgical technique and careful prosthetic design. * Immediate visibility: The anterior zone is the first thing people see when you smile. Any imperfection — a crown that is too long, too short, the wrong shade, or positioned even a millimetre too far forward or back — is immediately noticeable. * Bone resorption after extraction: When a front tooth is removed, the thin outer wall of bone often resorbs rapidly. If the implant is not placed at the right time with the right technique, this bone loss can lead to gum recession that exposes the metal implant collar — a devastating aesthetic failure.
1. Patient assessment and planning: The report emphasises the importance of comprehensive pre-operative analysis including CBCT imaging, digital smile design, and careful evaluation of the patient's smile line, lip dynamics, and smile makeover goals (thick or thin), and the condition of adjacent teeth. 2. Timing of implant placement: The consensus addresses when to place the implant — immediately after tooth extraction, early (4 to 8 weeks after extraction), or delayed (3 to 6 months after extraction). Each approach has specific indications depending on the bone and soft tissue conditions present. 3. Surgical technique: Recommendations cover implant positioning in three dimensions — the depth, the horizontal offset from the outer bone wall, and the angulation — all of which must be precisely controlled to achieve an optimal aesthetic result. 4. Provisional restoration: The report discusses the role of immediate provisional crowns — temporary teeth placed on the same day as implant surgery — in shaping the gum tissue contour while the implant heals. 5. Final restoration: Guidelines for the definitive crown material, shade matching, and emergence profile to achieve a result that is indistinguishable from a natural tooth.
As a Fellow and Diplomate of the Brånemark Osseointegration Centre and a co-author of this consensus report, Dr. Srinivas brings a level of expertise in anterior implant placement that is rooted in the highest international standards. At Maxface Dental Clinic, single anterior implant cases are planned with 3D imaging, digital workflows, and the precise protocols outlined in this publication — because your front tooth deserves nothing less than perfection.
Published: March 2020
Type: Consensus Report — Brånemark Osseointegration Centre India
Read the original publication on ResearchGate.
The main challenge in the aesthetic zone (front teeth) is achieving perfect tooth and gum aesthetics because the bone and gum tissue are naturally thin and highly visible.
According to clinical guidelines, it can be placed immediately, early (4-8 weeks), or delayed (3-6 months), depending on the patient's specific bone and soft tissue health.
Medically Reviewed By
MDS Prosthodontics, Fellow & Diplomate ICOI (USA) · Chief Implantologist · Last updated: May 2026
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