For our patient with the e-cigarette explosion, nearly 5 years passed since the initial event before definitive treatment was initiated. Forced eruption was used to pull down laterals #7 and 10 after years of root banking to draw down the soft tissue for more esthetic implant placement. Implants were placed at sites #7 and #10 ( Fig. 1 ) , supporting a 4-unit prosthesis across #7 to 10. Provisional implant restorations were used initially to sculpt gingival contours and encourage papilla regeneration ( Fig. 2 ) . Ridge augmentation and soft tissue grafting were performed as needed to optimize the esthetic outcome ( Figs. 3 and 4 ) . Crowns were later placed on the mandibular incisors once pulpal stability had been achieved. Final full-coverage restorations restored both function and esthetics ( Fig. 5 ).

Periapical radiographic of implant placement at site of prior root-banking for 21-year-old with history of e-cigarette related fracture of #7 and 10 and avulsion of #8,9 5 years prior.

Twenty-one-year-old with history of e-cigarette–related trauma: Provisional implant restoration.

Twenty-one-year-old with history of e-cigarette–related trauma: Dental papilla remnants before ridge augmentation.

Twenty-one-year-old with history of e-cigarette–related trauma: With provisional implant supported prosthesis.

Twenty-one-year-old with history of e-cigarette–related trauma: Delivery of final prostheses.

Definitive treatment plans often rely on an interdisciplinary approach to attain predictable outcomes. In our example, collaboration was paramount; it took nearly 5 years and coordination between multiple restorative dentists, 2 periodontists (grafting, implants, and soft tissue management), 2 orthodontists (growth monitoring and forced eruption), an endodontist (root canal therapy), a prosthodontist (mandibular crowns and maxillary implant supported bridge) and an oral surgeon (initial trauma management) to achieve the final result.

Forced eruption is the intentional orthodontic extrusion of a tooth toward the occlusal plane, and may be considered in instances of crown fracture to extend the ferrule in addition to its usefulness in soft tissue manipulation. Forced eruption both preserves and increases supporting bone. Occasionally, multiple phases of forced eruption may be indicated both preimplant and postimplant placement to ensure proper alignment of adjacent teeth.

Anterior implant placement is challenging because of the esthetic importance and difficulties related to the soft tissue and papilla. In situations where multiple implant placement is required, ideally, the implants are placed at least 3 mm apart. Proper implant placement technique, the size of implants used, and healing time are additional factors that will influence final esthetic outcomes, in addition to the quality and health of the patient’s baseline mucosa.

Ridge augmentation is a surgical procedure to increase the volume of alveolar bone (ridge) used to support and stabilize dental implants. The main technique for ridge augmentation is guided bone regeneration using barrier membranes and bone grafts, and it can be done at the same time as implant placement or before implant placement. ^,