Center Front Dental Implant -Ramsey Amin DDS

Center Front Dental Implant -Ramsey Amin DDS

Center Front Dental Implant -Ramsey Amin DDS

This is a great example of a difficult center front tooth dental implant .  The gum is thin and it is very scalloped.  I restored this case with a cemented  (rather than screw retained) custom zirconia abutment and porcelain crown.  The white zirconia underneath the gum line prevents the gray show through that many front dental implants have. 

The gum sometimes needs to be thickened as well which was done by a simultaneous gum graft at time of extraction along with a bone graft to fill the void between the implant and bone.  I made sure the gum line did not move by shaping and forming the gum to prevent black triangles and a long tooth.

Final photo was taken 3 years after the original just this week.

high scallop, thin tissue
custom cementable zirconia abutment
final crown 3 years after insertion
x-ray taken 3 years after placement-Ramsey Amin DDS

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


  1. After a fall in 2015, I broke my top front right tooth (#11, FDI), which was re-attached with a root canal in Dallas, TX. All went well for 5 years. In July 2020, while biting into a candy (big mistake!), I felt the tooth shifting upwards with a dull sound. The dentist took an x-ray (link below) and told me that the tooth has broken; exposed the part of the root with a laser, built up the tooth using post and composite resin, which is working OK for now.

    As a “permanent” solution, I was given the option of a dental implant or conventional bridge. Currently, I am based close to Singapore and am a bit apprehensive of doing a major work outside the US. While researching online, I landed on your page and came across your frank and honest responses to various implant questions. Thank you for your service.

    Could you please provide your opinion on getting an implant or a bridge right under the nose? I am 55, visibly healthy, have a deep bite and a tight space between the top and bottom teeth. As you say, these are body parts so I am trying to get the best I can afford and do it right the first time. Would appreciate if you can also comment if the treatment can be done in a single visit as the travel part is not too easy.

    Link to x-rays:

    August 22, 2020 at 10:22 pm Reply
    1. Ramsey Amin

      A single stage, immediate dental implant would be the best option. The deep bite and a tight space between the top and bottom teeth is a problem for both bridges and implants. But based on your simple x-ray this should be a slam dunk with an experienced dental implant specialist. Do your due diligence as front teeth are the most difficult of all. Stay safe!

      August 30, 2020 at 8:05 pm Reply
  2. DebbieG

    Dear Dr. Amin – I am a 62-year old woman with gum/perio issues and bone loss in some areas of my mouth. I keep regular hygiene appts and keep my teeth as clean as possible, always (no cavities in over 10 years, very few in my lifetime). I had a vertical cracked tooth, upper right bicuspid (? don’t know the tooth #) in 2014, it was removed and replaced with an implant. The implant is short and not useful except as a spacer between the upper teeth. A bridge was not done because of the location. I do not like having the implant. It was frightening to have my jaw drilled into, I thought it might crack during the procedure, and I have to work extra hard to clean around the implant and keep it infection free. I did not know that there is always a gap between the crown and gum. This isn’t the case with bridges, I have one which is pretty easy to clean and has been trouble free. As a result, I do not want another implant (although I am insured). In 2016 I noticed mobility in lower #29 – periodontist had me in 4x yearly for cleaning – I also kept a scrupulous cleaning regimen and the mobility went away. Then the Dr. abruptly retired and I have been without a good periodonist and hygienist for a year. (Just one cleaning in that time) Two weeks ago, both 29 and 30 suddenly became noticeably loose and infected – I went to a regular dentist who prescribed an antibiotic, and was referred to a periodontist who plans to remove these two teeth and wants to put in implants. I explained all of my above concerns to him, but he insists that I should not even consider a denture for those two spaces and would not even discuss it. His treatment plan is that I have the extractions, return later for bone grafting, and in several months, for implants. Question for you: Have you had patients wear dentures during the time they were awaiting implants, and how did that go? I am willing to at least try it. Thank you.

    October 22, 2018 at 2:24 am Reply
    1. RamseyAminDDS

      NOT NORMAL = “I did not know that there is always a gap between the crown and gum.”

      something sounds strange with how the tooth was restored. Sounds like you had a different person making the tooth and a different person during the surgery. Depending on their relationship I would suggest you see a third-party and have the area looked at. My guess is that it can be made to have no gap which will then look and feel normal.

      As for the lower arch, replacement with dental implants is the way to go. You can definitely where a small removable denture temporary during the process if the molars cannot be placed at the same time of extraction. Many people do not like this removable temporary denture and end up paying for it only for it to sit in the drawer.

      October 28, 2018 at 6:20 pm Reply
  3. Judith Barbera

    Hi Dr.,
    I had a front tooth extraction #8 on 9/4/18 along with a Bio-Oss bone graft in preparation for a dental implant. My plan is to go back to the surgeon in mid January 2019 to get the implant and have the permanent crown installed by my regular dentist in July 2019. (I’m spreading this out so I can pick up more dental insurance coverage as my dental coverage renews each July. After the tooth extraction, I waited a week and went to my dentist. We decided not to do a flipper because my dentist made a partial retainer for the top six front teeth and fashioned a tooth inside with bonding material. He curved it so it would make an oval shape in my gumline. I’ve been wearing the retainer for approx 4 weeks now and have noticed a high spot in the middle of the gumline which now make the gumline uneven (higher) when compared to the other front tooth.. My concern is this high spot might be seen when the abutment is attached to the permanent crown and my gumline will be higher and the metal abutment might even show. Is there anything I should do at this point. Should I go back to the surgeon or dentist to have them re-evaluate my gum and/or do a flipper instead? I’ve also heard that soft tissue grafts can be done to change the shape of a gumline. Please let me know what will be the best fix for this issue as I want to be pro-active at this point.
    Thanking you for your response,
    P.S. You have a great website loaded with lots of information. Thanks!!!

    October 3, 2018 at 9:31 pm Reply
    1. RamseyAminDDS

      It sounds like the temp is pushing too much on the gum. This is the time to correct it before going to the final. This other post will help you understand

      A long tooth is difficult to correct after the fact.

      October 8, 2018 at 1:37 am Reply
  4. Amina

    I just got an implant on my front tooth and a gum graph and a bone graph. I can’t wear my flipper anymore because my gums are swollen and the implants there so it’s hanging too low and my flipper won’t fit. I’m sure u can imagine what I’m talking about. I had an Essix made but it looks absolutely horrendous. What are my options? I’m going to university in one month and I just want to look normal please help me

    August 5, 2018 at 9:39 pm Reply
    1. RamseyAminDDS

      Need to remake ASAP. No reason this can’t look good.

      August 8, 2018 at 5:36 pm Reply
  5. Ky

    I am 10 days post front tooth implant with bone graft and temp put in place, and I am suddenly feeling an increase in pulsating and tingling today, I don’t know if I bumped it in my sleep or something, is there anything that the dentist can give me to brace my back teeth together so I don’t accidentally push on my front tooth? If I did push on it will it need to be redone completely? Could it be a sign of infection? The Zpac should just be going out of my system.

    July 30, 2018 at 5:43 pm Reply
    1. RamseyAminDDS

      You need to be seen. This is not normal. Z pack isn’t a great choice for this

      August 8, 2018 at 5:42 pm Reply
  6. Michael

    Dear Dr. Amin,

    I’m writing you on behalf of my mother actually. She had an implant on one of her incisors approx 10 yrs ago I believe and lately it has become loose and she has some signs of infection. She had an xray in early July and exam. She was told she would need a ‘new’ implant and bone graph. She is able to wiggle tooth on her own but it won’t simply ‘pull out’..but its loose. She sent me a picture of Xray and I didn’t notice bone loss really (perhaps not seen in that one view angle) Anyway, you mention on your blog that sometimes a bone graph can be done while leaving tooth and achor etc ‘in place’ I think you said ‘back’ teeth easier as they are thicker etc. My mom is healthy and slim & no meds I believe. she is over 70. I’m trying to help her make the right decision by researching.
    Is it most likely that her tooth ‘failed’ after 10 yrs because of infection that ‘then’ caused bone to soften? She says she is pretty good about brushing her teeth and flossing. Is it possible to graph bone to front incisor while implant stays in? I would sure hate for her to have to go through a complete removal..3 months healing…then graph 6-9 months..then essentially a ‘new’ implant from scratch. *she may have another xray (different angle) scheduled soon…as she didn’t want too many xrays all at once..I think she said. I sincerely appreciate your time, advice and opinion.

    Michael Roberts
    Hayward, CA

    July 26, 2018 at 3:05 am Reply
    1. RamseyAminDDS

      Thank you for your comments Michael. If implant is loose it cannot be rescued or recovered. The best course of action is to remove and replace. The condition is called peri-implantitis and is most likely what your mom has. Dental implants are not forever neither are crowns are fillings. that is a bunch of marketing garbage. I typically consider success to be 20-25 years so perhaps 10 years is premature but this can also be a bite issue as well without seeing her I cannot give you exact guidance except that staging the procedure as you have described is likely the best option. she must have a complete set of back teeth for the bite to be a nonissue. If she is missing back teeth are wears the partial the front implants are often overloaded.

      July 28, 2018 at 1:13 am Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!