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Case Study
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Selection and Ideal Tridimensional Implant Position for Soft Tissue Aesthetics

Learning Objectives:

This study reviews the importance of utilizing restoration-driven therapy for accurate implant placement. Upon reviewing this study, the reader will possess:

  • A heightened awareness of the role of soft tissues in aesthetic implant restorations.
  • An understanding of the functional and aesthetic factors that influence implant placement.

 

The single-unit implant-supported restoration is a reliable means of replacing a missing tooth. In order to be considered successful, an implant-supported restoration must achieve a harmonious balance between functional, aesthetic, and biological imperatives. This concept has resulted in the development of "restoration-driven implant placement," in which implants are positioned in relation to the anticipated requisites of the restorative phase rather than the availability of bone.

The development and maintenance of the aesthetic hard and soft tissue complex are important—particularly when implant treatment is performed in the aesthetic zone. The site selected for the implant must be guided in the mesiodistal, apicocoronal, and buccolingual dimensions by the anticipated restoration. The volume of the osseous support must allow the implant to be placed in the ideal situation, while the soft tissue morphology must mimic that of the adjacent teeth following the anticipated recession.

Implant selection and the interdental papilla volume (height and width) are determined by the implant's mesiodistal position. The length of the crown restoration is indicated by its buccopalatal orientation. The emergence profile and peri-implant pocket depth are influenced by the apicocoronal location. The cervical contour of the provisional restoration determines the shape of the buccal gingiva and height of the interdental papillae. Finally, the ceramic restoration must possess a form that complements the surrounding tissues, facilitates proper plaque control and occlusal function, and presents a harmonious natural appearance.

 

*Private practice, Paris, France 

  

Related Reading:

  1. Saadoun AP, Sullivan DY, Krichek M, LeGall M. Single-tooth implant: Management for success. Pract Periodont Aesthet Dent 1994;6(3):73-82.
  2. Garber DA, Belser UC. Restoration-driven implant placement with restoration-generated site development. Compend Cont Educ Dent 1995;16(8):796-804.
  3. Bahat O, Daftary F. Surgical reconstruction - A prerequisite for long-term implant success: A philosophic approach. Pract Periodont Aesthet Dent 1995;7(9):21-32.
  4. Hebel KS, Gajjar R. Achieving superior aesthetic results: Parameters for implant and abutment selection. Int J Dent Symp 1997;4:42-47.
  5. Adell R, Eriksson B, Lekholm U, et al. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Impl 1990;5(4):347-359.
  6. Tarnow DP, Magne AW, Fletcher P. The effect from the distance from the contact point to the crest of bone on the presence or absence of interproximal dental papilla. J Periodontol 1992;63(12):995-996.
  7. Weisgold AS, Arnoux JP, Lu J. Single-tooth anterior implant: A world of caution. Part I. J Esthet Dent 1997;9(5):225-233.
  8. Grunder U, Spielmann HP, Gaberthuel T. Implant-supported single tooth replacement in the aesthetic region: A complex challenge. Pract Periodont Aesthet Dent 1996;8(9):835-842.
  9. Saadoun AP. The key to peri-implant esthetics: Hard-and-soft tissue management. Dent Implantol Update 1997;8(6):41-46.
  10. Berglundh T, Lindhe J. Dimension of the peri-implant mucosa: Biological width revisited. J Clin Periodontol 1996;23(10):971-973.
  11. Bichacho N, Landsberg CJ. Single implant restorations: Prosthetically induced soft tissue topography. Pract Periodont Aesthet Dent 1997;9(7);745-752.
  12. Wohrle PS. The synergy of taper and diameter: Enhancing the art and science of implant dentistry with the Replace( implant system. Int J Dent Symp 1997;4:48-52.
  13. Buser D, Weber HP, Lang NP. Tissue integration on non-submergered implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants. Clin Oral Impl Res 1990;1(1):33-40.
  14. Alberktsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: A review. Int J Oral Maxillofac Impl 1986;1(1):11-25.
  15. Le Gall MG. The impact of occlusion on implants and implant componentry. Part 1. Dent Implantol Update 1996;7(8):61-64.
  16. Bengazi F, Wennstršm JL, Lekholm U. Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Impl Res 1996;7(4):303-310.
  17. Jovanovic SA, Paul SJ, Nishimura RD. Anterior implant-supported reconstructions: A surgical challenge. Pract Periodont Aesthet Dent 1999;11(5):551-558.
  18. Salinas TJ, Sadan A. Establishing soft tissue integration with natural tooth-shaped abutments. Pract Periodont Aesthet Dent 1998;10(1):35-42.
  19. Touati, B, Guez, G, Saadoun AP. Aesthetic soft tissue integration and optimized emergence profile: Provisionalization and customized impression coping. Pract Periodont Aesthet Dent 1999;11(3):305-314.
  20. Saadoun AP, Le Gall M. Periodontal implications in implant treatment planning for aesthetic results. Pract Periodont Aesthet Dent 1998;11(5):655-664.
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