Anterior Implant-Supported Reconstructions--A Case Report

Stefan J. Paul, DMD, PhD  •  Sascha A. Jovanovic, DDS, MS

Learning Objectives

After reviewing this case study, the reader should:

• Have a better understanding and visualization of the process of reconstructing implant supported restorations
• See how some cases are better solved using the interdisciplinary skills of various professionals

Interdisciplinary treatment planning and the development of a comprehensive surgical and restorative approach are critical factors in the final aesthetic success of a clinical case. Complete reconstruction of tooth- and gingiva-related aesthetics that match the appearance of the natural healthy tissues remains the ultimate objective of any treatment. 

To a large extent, the predictability of aesthetic success depends on the degree of tissue loss present at the initiation of the treatment. Consequently, the use of single-unit implant-supported restorations have a high degree of predictability, since the adjacent natural teeth--with intact bone and soft tissue attachment--can provide the morphological substructure that is required to restore natural gingival and papillary architecture. The objective of this article is to discuss contemporary techniques utilized to replace a single missing tooth in the anterior maxilla. 

Treatment of the anterior maxilla with implant-supported restorations remains a challenge and requires thorough treatment planning between the oral surgeon and the prosthodontist, particularly if the area of the deficient teeth is compromised by additional tissue loss. Fabrication of a waxup and a detailed stent for the implant placement appear to be helpful initial steps. A conservative treatment using primarily pressure to form the marginal tissues to the desired shape appears to improve the predictability of achieving an aesthetic result - even with compromised patients. In order to improve the long-term stability of such results, however, the interface between implants and abutments may require reconsideration. 

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