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Preserving Peri-Implant Architecture During Placement

Learning Objectives:

After watching this video, the viewer should:

  • Be able to visualize the of constructing a removable ovate pontic for the preservation of gingival architecture in the aesthetic zone.
  • See how to transition from an ovate pontic place holder to a definitive restoration while preserving gingival architecture.

 

Joseph Y.K. Kan, DDS, MS*

The impending loss of a single tooth in the anterior aesthetic zone can be a traumatic experience. Although single-tooth restoration with osseointegrated implants has been well-documented, successful placement of an anterior single implant may be complicated based on its position and surrounding tissue support. Numerous authors have demonstrated the significance of the underlying osseous structures to the ultimate location of the gingival tissue. Dentogingival dimensions of 3 mm facially of the failing tooth and 4.5 mm interproximally of the adjacent teeth must be established and the osseous architecture must be preserved for predictable implant aesthetics. Nevertheless, tissue stability of the anticipated implant restoration is dependent upon the periodontal form of the prospective implant site. Since gingival and interproximal papillary recession is difficult to regain, osseous structures must be preserved to ensure maintenance of the gingival architecture. If the failing tooth possesses a gingival architecture with proper underlying bony support that harmonizes with the surrounding dentition, these structures must be maintained using the appropriate surgical and prosthodontic techniques at the time of tooth extraction.

*Associate Professor, Department of Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, California.

 

Related Reading:

 

  1. Andersson B, Odman P, Lindvall AM, Lithner B. Single-tooth restorations supported by osseointegrated implants: Results and experiences from a prospective study after 2 to 3     years. Int J Oral Maxillofac Impl 1995;10(6):702-711.
  2. Avivi-Arber L, Zarb GA. Clinical effectiveness of implant-supported single-tooth replacement: The Toronto study. Int J Oral Maxillofac Impl 1996;11(3):311-321.
  3. Priest GF. Failure rates of restorations for single-tooth replacements. Int J Prosthodont 1996;9(1):38-45.
  4. Kois JC. Predictable single tooth peri-implant esthetics: Five diagnostic keys. Compend Contin Educ Dent 2001;22:199-208.
  5. Saadoun A, LeGall M, Touati B. Selection and ideal tridimensional implant position for soft tissue aesthetics. Pract Periodont Aesthet Dent 1999;11(9):1063-1072.
  6. Salama H, Salama M, Garber D, Adar P. Developing optimal peri-implant papillae within the esthetic zone: Guided soft tissue augmentation. J Esthet Dent 1995;7(3):125-129.
  7. Phillips K, Kois JC. Aesthetic peri-implant site development. The restorative connection. Dent Clin North Am 1998;42(1):57-70.
  8. Kan JYK, Rungcharassaeng K. Site development for anterior implant esthetics: The edentulous site. Compend Contin Educ Dent 2001;22:221-232.
  9. Kois J. Altering gingival levels: The restorative connection. Part I: Biologic variables. J Esthet Dent 1994;6:3-9.
  10. Kan JYK, Rungcharassaeng K. Immediate placement and provisionalization of maxillary anterior single implants: A surgical and prosthodontic rationale. Pract Periodont Aesthet Dent 2000;12(9):817-824.

 

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