Clinical Considerations for Preservation of the Gingival Architecture in Hopeless Adjacent Anterior Teeth
Ramón García-Adámez Soto, DDS, MS
This case study evaluates factors that may influence the dynamics of peri-implant gingival aesthetics in the event of adjacent anterior failing teeth; it also describes a surgical and prosthodontic technique that may assist the restorative team in achieving a predictable objective. Upon completing this case study, the reader should:
- Understand the role of interdental papillae on restorative success.
- Recognize the importance of accurately managing the soft peri-implant architecture during surgical procedures in order to avoid the remodeling and resorption of the soft tissues.
Traditionally, one of the primary objectives of implant therapy was to ensure osseointegration and to deliver a restoration that would reconstruct the form and improve function. While these objectives remain a priority in contemporary restorative treatment, alternative concerns include the preservation of tissue and optimization of the soft tissue contour, simplification of treatment, reduction of sequences, patient comfort, and development of an optimal aesthetic result.
When treating failing adjacent teeth in the aesthetic zone with an otherwise healthy periodontium and complete dentition in patients with a high smile line, the development of optimal gingival aesthetics is paramount. Bone resorption, unfortunately, is common following the removal of adjacent anterior teeth, and it is extremely difficult to avoid remodeling of gingival tissue levels and interproximal papillae. A combination of improper implant placement and/or inadequate osseous-gingival support may similarly result in compromised aesthetic outcomes. This article evaluates factors that may influence the dynamics of peri-implant gingival aesthetics in the event of adjacent anterior failing teeth; it also describes a surgical and prosthodontic technique that may assist the restorative team in achieving a predictable objective.
To obtain ideal implant aesthetics, the role of the interdental papilla is essential. The papilla height and form should be restored to the original situation observed in natural teeth in cases of adjacent failing teeth. In the case presented herein, various techniques were used to establish the ideal situation. This included atraumatic extraction procedures, immediate implant insertion, concave profile of the provisional abutment, and the root submergence technique. However, the most important factor in these cases is the management of the soft peri-implant architecture during the procedure in order to avoid soft tissue remodeling and resorption.
*Associate professor, Postgraduate Studies, Conservative and Esthetic Department, Complutense University; private practice, Madrid, Spain.
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