Dr Sinéad Mallon

Patients do not come here for implants. They come here for teeth. The implant is the part underneath that makes the teeth possible, and my job is everything you can actually see.

How a restorative dentist plans the teeth before the implants

On a well-run case, the finished tooth is designed first and the implant position is worked backwards from it. That sounds obvious and it is frequently done the other way round — the implant goes where the bone is generous, and the tooth is then made to reach it. The result holds perfectly well and looks like a compromise, because it is one.

Niall and I plan together from the same 3D scan. I decide where the tooth needs to be for the smile line, the bite and the way your lip moves. He decides how to get an implant into a position that supports it, and whether that needs bone building up first.

Why single front teeth are the hard ones

People assume a full arch is the difficult case and a single tooth is simple. It is the reverse. A full arch has no neighbours to be compared against — everything is new, so everything matches. A single upper front tooth sits beside a natural tooth that has thirty years of staining, wear and translucency in it, and the eye is very good at spotting a tooth that is trying too hard.

That case is a shade-matching problem more than a surgical one. I take the shade in daylight, not under the surgery light. Marek makes the crown in the laboratory on the premises, so he can come down and look at your actual mouth rather than work from a photograph and a number. If the first attempt is not right, we remake it — which is a good deal easier to say when the laboratory is upstairs.

The gum matters as much as the tooth

The line where the tooth meets the gum is what gives an implant away. Getting it right depends on how the gum was handled at the surgery and how the temporary was shaped in the months of healing, which is why the temporary crown is not a throwaway. It is what trains the gum into the shape the final tooth will sit in.

That is also why full arch cases are reviewed at the temporary stage rather than rushed to the finish. You wear the temporary bridge for four months. If something about it is not right — the length, the shape, the way it sounds when you say certain words — that is what those four months are for.

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