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Treatmentplanningofimplantsintheaestheticzone●Thepredictabilityofaestheticsuccessdependsontissuelossattheinitiationoftreatment.
●Specificimplantsystemsanddesignsdonoguaranteeaestheticoutcomes.
●Hardandsofttissuedeficienciesmustbeaddressedpriortoimplantplacement.
●Recreatingpapillabetweenmultipleadjacentimplantsisnotpredictable.Inthelast10yearsthefocushasshiftedfromosseointegration,tocreationofanimplantbornerestorationwhichisinharmonywiththesurroundinghardandsofttissue..
Replacementofmultiplemissingteethin
theaestheticzoneischallengingparticularly
whenthethreedimensionalarchitectureofthe
existingboneandsofttissueisdeficient..
Thereisnotasinglecomponentavailablefromamanufacturerwhichwouldbetheidealreplacementforamaxillarycentralincisor..Thepredictabilityoftheaestheticoutcome
ofanimplantrestorationisdependentonmany
variablesincludingbutnotlimitedtothefollowing:
1)Patientselectionandsmileline
2)Toothposition
3)Rootpositionoftheadjacentteeth
4)Biotypeoftheperiodontiumandtoothshape
5)Thebonyanatomyoftheimplantsite
6)Thepositionoftheimplant.1.Patientselectionandsmileline
Notice:
Theclinicianmustunderstandthepatient’sdesires.
Theaestheticzoneiswherethepatientthinksitis.
Theclinicianshouldbeawarethatthepatientwhopresentswithunacceptabletoothhealth,shadeor
positionmaynotgiveafullsmilewhenasked.
2.Toothposition
Inmanyinstancesteethwithapoorprognosisarethoughtlesslyextracted.
Apico-coronal:moreapical,morecoronaloridealandmimictheleveloftheadjacentgingivalmargin.
orthodonticextrusion
Facio-lingual:positionedtoofarfacially,boneaugmentationprocedures;
positionedmorelingually,morefavourable
Mesio-distal:beequaltothatofthecontralateraltooth;orthodontics,enameloplastyorrestorations3.Rootpositionoftheadjacentteeth
decreasetheverticalboneheight,harmproximalgingivalarchitecture
orthodonticstorepositionmalposedteeth4.Biotypeoftheperiodontiumandtoothshape
BiotypeⅠ:
Athinbiotypewillrequiretheimplantbodyandshouldertobeplacedmorepalataltomaskanytitaniumshowthrough.
Whenimplantsareplacedtowardthepalatea
slightlydeeperplacementisrequiredtoallow
forproperemergenceprofile
BiotypeⅡ:
Ideallythefacialcontourshouldbeslightlyflatterthanthecontralateralnaturaltoothtominimiseapicaldisplacementofthefreegingivalmarginafterinsertion.
5.Thebonyanatomyoftheimplantsite
Thedefinitiveimplantrestorationneedstobesurroundedbyahardandsofttissueenvironmentwhichisinharmonywiththesurroundingdentition
Adiagnosticwaxuphighlightingtissuedeficienciesandfinaltoothpositioningcanassistintheplanningprocess①Facio-lingualridge
②Mesio-distalspace
③apicocoronaldimension
apicocoronaldimension
●Heightandthicknessoffacialbonywall
theverticaldistanceofthedentogingivalcomplexonthemidfacialaspectis3mm,aslightapicallossoftissueupto1mm.Greaterorlesserthan3mmindicatesthechangewillberelativelynegligibletomorethan1mm.
●Heightofbonycrestintheinterproximalarea
theheightofperi-implantpapillaeinsingletoothgapsisindependentoftheproximalbonelevelnexttotheimplantbutisdependentontheinterproximalboneheightoftheadjacentteeth6.Thepositionoftheimplant
Ifthetoothtobereplacedhasnotyetbeenremoved,severaldeterminationsshouldbemadepriortotheextractionApico-coronalplacement
Theapico-coronalpositioningoftheimplantistheverticaldiscrepancybetweentheocclusalsurfaceoftheimplantandthepeaksofthebonyseptaproximaltotheadjacentteeth,themostpleasingaestheticresultoccurswhenthisdiscrepancyisminimal.
Averticaldistanceof3-4mmisneededforgradualtransitionfromthe4mmdiameteroftheimplantplatformtothe7-8mmdimensionatthegingivalmargin。Mesio-distalplacement
Poorembrasureformandemergenceprofile
willresultinarestorationwithalongcontact
zoneandcompromisedclinicaloutcomesFacio-lingualplacement
•Thecrestwidthneedstobeexaminedto
determinethepresenceorabsenceofbone
atrophy.
•Placementwillvarydependingonthemechanism
ofretentionofthefinalrestoration
(screwretainedvs.cementretained).
•Deficientalveolarcrestwidthmayrequire
augmentationsothattheimplantcanbepositioned
inthecorrectfacio-lingualposition.Considerationsformultipleimplants
whentwoimplantsareplacedadjacenttoeachotherintheaesthet
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