Ross Enfinger ***And no, I'm not referring to the girl or guy you picked up at the 2am dive bar last weekend. 
Of course, we're always chasing perfection that doesn't truly exist, but there are clinical scenarios where achieving a level "10" outcome is impossible. The following case is one that I took over after implants #7, 8, and 9 were already placed and after the patient had become frustrated with multiple try-ins of the final implant restorations at another office. The esthetic problems were numerous and the placement of the implants posed a significant challenge, so I was careful to under-promise when discussing possibilities with this patient. Ultimately, she took the "it couldn't possibly be worse" approach and allowed me to re-design her smile. So off we went...
With an approved FGTP template to guide us to the end result, I did a quick physical wax-up to estimate the midline correction, performed crown lengthening #5, 6, 11, and 12 to bring their gingival zeniths apically to closer match the soft tissue around the implants, and provisionalized #6-11.
After 6 months of healing, we finally moved on to the final restorations #6-11 via Biocopy of the provisionals. We had to fight dark teeth, unfavorable implant angulations, and even needed some Juvederm to coax the flat gingival architecture into some semblance of a scallop. It was a ton of effort just to get a "7" result for this awesome patient who has truly been a "10."
