Does a fixed rehabilitation on implants look natural, or can you tell it is a prosthesis?

This is one of the most common concerns among people considering a fixed rehabilitation, and it is rarely put directly. It deserves a clear answer.

What determines how natural the result looks is not only the making of the prosthesis. It is, before that, the surgical planning: assessing the bone and gingival structure that has been lost, and establishing from there the correct positioning of the implants, so that the prosthesis can be made with appropriate proportions.

Prostheses with and without artificial gum: what is the difference?

A classification used in implant dentistry distinguishes fixed prostheses according to the structures they replace: FP-1, FP-2 and FP-3 ^[1].

The FP-1 and FP-2 prostheses are characterised by reproducing only the teeth: there is no artificial gum and no visible transition. Each tooth emerges from the patient's own gum, and all the aesthetic work is concentrated on the shape, the colour and the characterisation of the teeth. They require bone and gingival conditions compatible with that result.

The FP-3 prosthesis replaces the teeth and also the volume of tissue that has been lost, including a component of characterised artificial gum. It is the solution indicated when there is extensive loss of bone structure, and it is what makes it possible to restore appropriate proportions to the teeth when that loss would otherwise rule them out.

This classification helps to explain the options, but it does not establish an aesthetic hierarchy: each design has its own indications and its own limitations.

What determines which of them is possible

The choice depends above all on three clinical factors, considered together with the patient's expectations.

The amount of tissue lost. When there is substantial loss of bone and gum, replacing only the teeth would produce proportions that look unnatural. In those cases it is necessary to assess how to recover the missing volume — through the prosthesis and, when indicated, through tissue reconstruction procedures.

The smile line. The amount of teeth and gum on display when smiling shapes the aesthetic result. In a prosthesis with artificial gum, it is particularly important to assess whether the transition to the patient's own gum is visible. A high smile line makes that integration more demanding.

Lip support. The loss of teeth and tissue alters the support of the upper lip. The planning assesses how much of that support needs to be recovered and in what way, while maintaining appropriate facial proportions and conditions that allow for hygiene.

Making the prosthesis: an in-house laboratory

Our clinics include an in-house dental laboratory. This allows direct communication between the dentist and the dental technician who will make the final rehabilitation, and makes it possible to follow every stage of the work.

That proximity makes it possible to relate the adjustments to the prosthesis to what I observe clinically: the way the patient smiles, speaks and chews, the support of the lips, how easy it is to keep clean.

In making it, both the aesthetic details and the biological and functional requirements are taken into account: the emergence profile — the way the prosthesis relates to the gum —, the contours of the surfaces, access for hygiene and the contacts between the teeth.

The aesthetics are worked on in the individual shape of each tooth, in the colour, the translucency and the surface texture. Where there is artificial gum, its shape and characterisation also form part of that work.

The aim is to build a smile that fits the features and the preferences of each person.

How we assess which indication is best for each patient

The assessment takes into account the remaining bone and gingival volume, the display of the teeth at rest, the smile line, the movement of the lips when speaking and smiling, and the patient's aesthetic expectations.

Photographs, videos and try-ins of the rehabilitation, when indicated, help to assess that integration and to communicate the intended result.

We frequently make use of a facial scanner, which makes it possible to plan the smile in advance. It is that planning which gives us certainty about the type of rehabilitation we are going to obtain, and which makes the result predictable before any procedure.

Before starting a rehabilitation, all these aspects are discussed with the patient: whether artificial gum will be needed, what tooth proportions are possible, and what compromises can be foreseen. The result is then refined and reassessed over the course of the treatment.

This is a conversation we have at the outset, so that the patient understands the plan and takes part in the decisions about their smile.