explain different approaches to satisfy implant esthetics

1. DR. LAJU S MDS
Associate professor , Malabar dental college & research centre
Edappal

2.  Dental implant- one of the best options to
replace single missing tooth in the aesthetic
area
 Survival rates of dental implants are well
documented
 Esthetic zone implant rehabilitation is
challenging to practitioners

3.  Anterior implant rehabilitation needs to
strongly consider - bone factors
 soft tissue factors and
 prosthetic factors of the
implant intended area

4. Implant stability
Absence of pain / inflammation
◦ Marginal bone loss
◦ Absence of peri -implant radiolucency

5.  Use composite measures which include
 Patient reported outcome measures
 Peri-implant tissue health(hard and soft
tissue)
 Functional and Esthetic outcomes related
to implant supported reconstruction

6.  Implant esthetic result is the combination of
appearance of mucosa and esthetics of prosthetic
reconstruction

9.  Numerous factors influence the esthetic
outcome of implant rehabilitation, two main
factors are bone and soft tissue deficiencies
in the intended implant site

10.  Class 1
 No discrepancy exist
between ideal position
of implant , implant
supported prosthetic
unit and alveolar bone
anatomy
 Ideal situation for
implant placement

11.  Class 11
 Moderate horizontal defect
 In this situation, implants
can be placed in
prosthetically driven
position but simultaneous
hard and soft tissue
augmentation procedures
are indicated or use of
osteotomes to expand the
available bone volume

12.  Class III
 Significant horizontal bone
defect
 This situation doesn’t allow
implant to be placed in ideal
prosthetic position
 Immediate implant placement
is not possible even after
surgical correction of the
defect

13.  Guided bone regeneration
technique with autogenous
particulate bone graft with
semi permeable barrier.
 Autogenous bone block
harvested from intra oral or
extra oral donor site
 Adequate healing period is
must (6-9months)

14.  ClassIV
 A combination of
horizontal and vertical
defect
 Apart from above
mentioned surgical
procedures, LeFort I
osteotomy with
advancements and
lowering of the maxilla
with inter positional bone
graft can be done

15.  Timing of implant placement
 Correct three dimensional position of the fixture
 Platform switching
 Implant abutment morphology and restoration
crown contour

16.  Type 1 - Immediate implant placement
 Type 2 -Early placement with soft tissue
healing
 Type 3. - Early placement with partial bone
healing
 Type 4 - Delayed / late implant placement

17.  Type I is ideal
 Should be accompanied with bone graft and
provisional restoration

18.  Objectives are :-
 To minimise the resorption of bundle bone
 To maintain the correct distance between
the adjacent teeth/implant to preserve
adequate blood supply and maintain hard
and soft tissue health
 To allow correct prosthetic phase

25. Teeth Mesiodistal
width of crown
Mesiodistal
width at CEJ
Implant
diameter
Central incisor 8.6mm 5.5mm 4-5 mm
Lateral incisor 6.5mm 4.3mm 3-3.25mm
Canine 7.6mm 4.6±1mm 4/ 5mm
1st premolar 7.1mm 4.2±1mm 4/5mm

26.  Objectives are to reduce peri-implant bone
loss and preserving the soft tissue level

28.  Circumferential microgrooves in transmucosal zone create a
void chamber in which blood clot forms and provides soft
tissue growth and thickening
 Curved profile allows increased area of interface between the
soft tissue and implant
 After soft tissue maturation , a ring like seal mimicking the
effect of sharpeys fibers on natural tooth is created

29.  Contributes strongly to maintain healthy and
thick soft tissues
 Restoration contour is
divided into 2 portions
1. Critical contour
2. Subcritical contour

30.  Critical contour should resemble
physiologic contour of natural tooth
 Subcritical contour should be concave ,
allowing growth of soft tissue

31.  Emergence
profile of tooth is
straight
 Cervical contour
is convex
 Emergence angle
for extracted
maxillary teeth -
150

32.  Ideal implant position prescribed
in literature is cingulum
of the future restoration
 More palatal the implant,
more will be the cervical contour
and emergence angle

34.  The implantological rehabilitation of esthetic zone is one of
the most demanding and complex treatments due to the
necessity to obtain an optimum esthetic result.
 Many factors in terms of hard and soft tissue and prosthetic
phase have to be considered before planning the implant in
esthetic zone
 Though the osseointegration and restoration of function and
soft tissue esthetics dictate implant success, the patient’s
satisfaction is a key element of the success of implant therapy

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