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    For many patients who are missing three or more anterior teeth, an implant-supported FPD may be the best choice, especially if the remaining teeth would not make good abutments because of their structural condition. In fact for a patient missing both maxillary centrals but who has poor bone in the missing central incisor locations for implants, but also very poor lateral incisors from a structural perspective, it may be beneficial to consider sacrificing the lateral incisors and placing two implants in their location to create a four-unit implant-supported FPD rather than consider extending a tooth-supported FPD to the canines.

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    The one challenge we still have with replacing multiple missing anterior teeth with implants is placing an implant for every missing anterior tooth; to date it’s very difficult to manage the gingival esthetic outcome when an implant is used for every missing anterior tooth. Typically separating implants with a pontic, except for adjacent central incisor implants, generally produces a more predictable esthetic result.

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