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Maintaining the Soft Tissue for Hopeless Teeth

When treating failing adjacent teeth in the aesthetic zone, the development of optimal gingival aesthetics is paramount.  Care must, however, be taken to ensure that sufficient peri-implant support is available to provide a natural-looking emergence profile.  The purpose of this podcast is to evaluate the potential causative factors that may compromise peri-implant gingival aesthetics, particularly when treating adjacent failing teeth in the anterior region. A concise surgical and prosthodontic technique was presented to ensure development of a natural-looking restoration with optimal results.

*Associate professor, Postgraduate Studies, Conservative and Esthetic Department, Complutense University; private practice, Madrid, Spain.


Learning Objectives:

This podcast 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 podcast, the listener 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.


Related Reading:

  1. Kois J, Kan J. Predictable peri-implant gingival aesthetics: Surgical and prosthodontic rationales. Pract Proced Aesthet Dent 2001;13(9):691-698.
  2. Kois, J. Predictable single-tooth peri-implant esthetics: Five diagnostic keys. Compend Contin Educ Dent 2004;24(11):895-902.
  3. Belser U, Buser D, Higginbottom F. Consensus statements and recommended clinical procedures regarding esthetics in implant dentistry. Int J Oral Maxillofac Impl 2004;19(suppl):73-74.
  4. Funato A, Salama M, Ishikawa T, Garber D, Salama H. Timing, positioning and sequential staging in esthetic implant therapy: A four-dimensional perspective. Int J Periodont Rest Dent 2007;27: 313-323.
  5. Elian N, Jalbout ZN, Cho SC, et al. Realities and limitations in the management of the interdental papilla between implants: Three cases reports. Pract Proced Aesthet Dent 2003;15(10):737-744.  
  6. Mankoo, T. Contemporary implant concepts in aesthetic dentistry – Part I: Biological width. Pract Proced Aesthet Dent 2003;15(10):737-744.
  7. Choquet V, Hermans M, Adriaenssens P, et al. Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region. J Periodontol 2001;72(10):1364-1371.
  8. Vailti F, Belser U. Replacing four missing maxillary incisors with regular or narrow-neck implants: Analysis of treatment options. European J Esthet Dent 2007;2(1):42-57.
  9. Tarnow DP, Elian N, Fletcher P, et al. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2003;74(12):1785-1788.  
  10. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 2000;71(4):546-549.
  11. Testori T, Bianchi F, Del Fabbro M et al. Implant aesthetic score for evaluating the outcome: Immediate loading in the aesthetic zone. Pract Proced Aesthet Dent 2005;17(2):123-130.
  12. Leziy S, Miller B. Replacement of adjacent missing anterior teeth with scalloped implants: A case report. Pract Proced Aesthet Dent 2005;17(5):331-338.
  13. Mankoo T. Contemporary implant concepts in aesthetic dentistry – Part 3: Adjacent immediate implants in the aesthetic zone. Pract Proced Aesthet Dent 2004;16(4);327-334.
  14. Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodont Rest Dent 2006;26:9-17.
  15. Baumgarten H, Cocchetto R, Testori T, et al. A new implant design for crestal bone preservation: Initial observations and case report. Pract Proced Aesthet Dent 2005;17(10):735-740.  
  16. Rungcharassaeng K, Kan JYK. Aesthetic implant management of multiple adjacent failing anterior maxillary teeth. Pract Proced Aesthet Dent 2004;16(5):365-369.
  17. Gamborena I, Blatz MB. Current clinical and technical protocols for single-tooth immediate implant procedures. Quint Dent Technol 2008;31:49-60.
  18. Leziy S, Miller B. Prefabricated zirconia abutments: Surgical and restorative advantages, handling considerations, and clinical outcomes. Quint Dent Technol 2008;31:95-104.
  19. Salama M, Ishikawa T, Salama H, Funato A, Garber D. Advantages of the root submergence technique for pontic site development in esthetic implant therapy. Int J Periodont Rest Dent 2007;27:521-527.
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