Treatment planning of implants/prosthodontic courses

TREATMENT
PLANNING OF
IMPLANTS IN THE
AESTHETIC ZONE
INDIAN DENTAL ACADEMY
LEADER IN CONTINUING Education
www.indiandentelacademy.com

INTRODUCTION
THE PREDICTABILITY OF AESTHETIC SUCCESS
DEPENDS ON THE TISSUE LOSS PRESENT AT THE
INITIATION OF THE TREATMENT
THE GREATER THE BONE AND SOFT TISSUE LOSS,
THE MORE DIFFICULT IT BECOMES TO PRODUCE AN
IDEAL AESTHETIC RESULT
SINGLE TOOTH IMPLANTS HAVE A HIGH DEGREE OF
PREDICTABILITY AS THE ADJACENT TEETH PROVIDES
THE MORPHOLOGICAL SUBSTRUCTURE THAT IS
REQUIRED TO RESTORE THE NATURAL GINGIVAL
AND PAPILLARY ARCHITECTURE.

DIAGNOSIS AND APPROPRIATE TREATMENT
PLANNING ARE CRITICAL IN OBTAINING A
SUCCESSFUL OUTCOME.

BONE RESORPTION FOLLOWING ANTERIOR TOOTH
EXTRACTION OFTEN COMPROMISES GINGIVAL TISSUE
LEVELS FOR THE IMPLANT SUPPORTED
RESTORATIONS.

PRIMARY OBJECTIVE:
COMPLETE RECONSTRUCTION OF TOOTH AND
GINGIVAL RELATED AESTHETICS.
PREDICTABILITY:
DEPENDS ON THE TISSUE LOSS PRESENT AT THE
INITIATION OF TREATMENT.

DIAGNOSIS AND TREATMENT PLANNING PLAY A
VERY IMPORTANT ROLE FOR A SUCCESSFUL
OUTCOME.
TREATMENT PLANNIG MUST ADDRESS HARD AND
SOFT TISSUE DEFICIENCIES AND COMBINE THIS
WITH PRECISION IN IMPLANT PLACEMENT.

FACTORS AFFECTING AESTHETIC OUTCOME .
PATIENT SELECTION AND SMILE LINE.
TOOTH POSITION.
ROOT POSITION OF THE ADJACENT TEETH.
BIOTYPE OF THE PERIODONTIUM AND TOOTH
SHAPE.
THE BONY ANATOMY OF IMPLANT SITE.
THE POSITION OF THE IMPLANT.

PATIENT SELECTION AND SMILE LINE.
PATIENT DESIRES.
BENEFITS OF IMPLANT RESTORATION.
ADDITIONAL LENGTH OF TIME.
ADDITIONAL COST.

PATIENTS AESTHETIC
EXPECTATIONS MUST
BE EVALUATED
TOGETHER WITH
THERE LIP ACTIVITY
AND LIP LENGTH.

TOOTH POSITION
TOOTH POSITION
APICOCORONAL FACIOLINGUAL MESIODISTAL

APICO CORONAL POSITION:
THE GINGIVAL MARGIN OF
TOOTH TO BE EXTRACTED
FOR IMMEDIATE PLACEMENT
MUST BE EVALUATED.

MESIODISTAL POSITION:
IDEALLY THE MESIODISTAL
TOOTH WIDTH SHOULD BE
EQUAL TO THE WIDTH OF THE
CONTRALATERAL TOOTH
FOR AN GOOD AESTHETIC
OUTCOME.
EXCESSIVE MESIO DISTAL
SPACE IN THE REGION
REQUIRING IMPLANT
RESTORATION.
RESTORATION
RESULTING WITH
ABSENCE OF
INTERDENTAL PAPILLA

ROOT POSITION OF THE ADJACENT TEETH.
TEETH WITH ROOT PROXIMITY OFTEN PRECLUDES
PLACING OF IMPLANTS. THE THIN BONE PRESENT
CREATES A GREATER RISK OF LATERAL RESORPTION
LEADING TO DECREASE IN THE VERTICAL BONE
HEIGHT AFTER EXTRACTION OR IMPLANT
PLACEMENT.

BIOTYPE OF PERIODONTIUM AND TOOTH SHAPE.
THIN SCALLOPED
PERIODONTIUM
THIN BIOTYPE REQUIRES THE IMPLANT BODY AND
SHOULDER TO BE PLACED MORE PALATALLY TO
MASK ANY TITANIUM SHOWTHROUGH.
THICK,FLAT
PERIODONTIUM.

Thin scalloped
>15%
DELICATE SOFT TISSUE CURTAIN
DEHISCENCE AND FENESTRATION
REDUCED QUALITY AND QUANTITY OF KERATINISED
GINGIVA.
REDUCED FACIALLY AND INTER PROXIMALLY WITH
INSULT

THICK FLAT
DENSER MORE FIBROTIC SOFT TISSUE CONTOUR
INCREASED QUALITY AND QUANTITY OF THE
KERATNISED MUCOSA
POCKET FORMATION WITH INSULT
CONTACT AREAS ARE LOCATED MORE TOWARDS
THE MIDDLE THIRD OF THE TOOTH

IDEALLY THE FACIAL
CONTOUR SHOULD BE SLIGHTLY
FLATTER THAN THE CONTRALATERAL
NATURAL TOOTH TO MINIMISE APICAL
DISPLACEMENT OF THE FREE GINGIVAL MARGIN
AFTER INSERTION.
OVER CONTOURING OF IMPLANT PROVISIONAL
RESTORATION AS IT EMERGES FROM THE FREE
GINGIVAL MARGIN RESULTING IN APICAL MIGRATION
OF THE SOFT TISSUES.

BONY ANATOMY OF IMPLANT SITE.
BONY ANATOMY OF THE SITE MUST HAVE A THREE
DIMENSIONAL CONFIGURATION THAT PERMITS
PLACEMENT OF THE IMPLANT IN RESTORATIVELY
IDEAL POSITION.
BONE GRAFTING IS ADVISED IN CASE OF ANY
INADEQUACIES.
INADEQUATE BUCCOLINGUAL
WIDTH FOR IMPLANT
PLACEMENT.

IMPLANT POSITION
IMPLANT SHOULD BE
PLACED SUCH THAT IT
ALLOWS THE
MAINTENANCE OF
BOTH HARD AND SOFT
TISSUE ARCHITECTURE.
Implant
position
Apicocoronal
placement
Mesiodistal
placement
Faciolingual
Placement.

•APICOCORONAL PLACEMENT
IMPLANT SHOULD BE PLACED 3-
4mm APICAL TO THE EXISTING
FREE GINGIVAL MARGIN.
ADEQUATE ROOM IS REQUIRED
FOR THE TRANSITION FROM
THE HEAD OF THE IMPLANT TO
THE POINT WHERE THE
RESTORATION EXITS THE
FREEGINGIVAL MARGIN.
IDEAL PLACEMENT
SHALLOW PLACEMENT OF AN
IMPLANT RESULTING IN
INADEQUATE SPACE FOR
TRANSITION AND A SHORT
RESTORATION IN LENGTH.

MESIODISTAL PLACEMENT
IMPROPER MESIODISTAL POSITIONING OF IMPLANTS
CAN HAVE A SUBSTANTIAL EFFECT ON THE
GENERATION OF INTERPROXIMAL PAPILLARY
SUPPORT AS WELL AS ON THE OSSEOUS CREST OF
THE ADJACENT TEETH.
IT SHOULD BE PLACED 1.5-2mm FROM AN ADJACENT
TOOTH.

FACIO LINGUAL POSITION
THE AMOUNT OF AVAILABLE BONE SHOULD BE
ATLEAST 1mm GREATER THAN THE IMPLANT
DIAMETER ON EACH SIDE.
IDEAL IMPLANT PLACEMENT SHOULD
BE PALATAL TO AN IMAGINARY LINE
THAT OUTLINES THE CURVATURE OF
THE TEETH

TWO ANATOMIC STRUCTURES ARE IMPORTANT IN
DETERMINING THE PREDICTABILITY OF THE SOFT
TISSUES AFTER IMPLANT PLACEMENT
1. HEIGHT AND THE THICKNESS OF THE FACIAL BONE
WALL AND
2. BONE HEIGHT OF THE ALVEOLEAR CREST IN THE
INTER PROXIMAL AREA.

. HEIGHT AND THE THICKNESS OF THE FACIAL BONE
WALL
THIS WAS BASED ON THE VERTICAL DISTANCE OF
THE OSSEOUS CREST TO THE FREE GINGIVAL
MARGIN.
THE GREATER THE DISTANCE THE GREATER WILL BE
THE RISK AFTER AN INVASIVE PROCEDURE
MEASURING THIS HEIGHT BEFORE AN EXTRACTION
WILL HELP US ANTICIPATE THE FINAL POSITION OF
THE FREE GINGIVAL MARGIN

BONE HEIGHT OF THE ALVEOLEAR CREST IN THE INTER
PROXIMAL AREA.
THIS PLAYS AN IMPORTANT ROLE IN THE PRESENCE
OR ABSENCE OF PERI-IMPLANT PAPILLAE.

IMPLANT POSITION

RESTORATION DRIVEN IMPLANT PLACEMENT
CONCEPT.
OPTIMAL ESTHETIC IMPLANT RESTORATION
DEPENDS ON PROPER THREE DIMENSIONAL
IMPLANT POSITIONING.
FOUR POSITIONAL PARAMETERS CONTRIBUTE TO
THE SUCCESS OF THE RESTORATION AND MUST BE
CAREFULLY CONSIDERED DURING IMPLANT
PLACEMENT.

BUCCOLINGUAL POSITION:
BUCCAL DEHISCENCE
RESTORATION
PALATAL RIDGE LAP
UNHYGIENIC, UNAESTHETIC
BUCCAL WALL THICKNESS 1MM TO PREVENT
RECESSION.

MESIO-DISTAL
DECREASED PAPILLARY HEIGHT
RESTORATIVE PROBLEMS
POOR EMBRASSURE FORM AND EMERGENCE
PROFILE
LONG CONTACT ZONE

APICO CORONAL
ERRORS IN APICO CORNAL IMPLANT
PLACEMENT CAN HAVE SERIOUS AESTHETIC
AND BIOMECHANICAL IMPLICATIONS.
AN IMPLANT PLACED TOO CORONALLY WILL
ALLOW ADEQUATE TRANSITION FROM THE
HEAD OF THE IMPLANT TO THE POINT WHERE
THE RESTORATION EXITS FROM THE FREE
GINGIVAL MARGIN

TOO DEEP IMPLANT
PLACEMENT
DIFFICULTY IN IMPRESSION MAKING
DIFFICULTY IN INSTRUMENTATION
TISSUE IMPENGINGMENT

CONSIDERATIONS FOR MULTIPLE IMPLANTS

CONCLUSION
WHEN A PATIENT HAS A MISSING ANTERIOR TEETH
AND DESIRES REPLACEMENT, ADECISSION SHOULD
BE MADE WHETHER HE HAS TO GO FOR A BRIDGE OR
AND IMPLANT OR A RESIN BONDED PROSTHESIS
AFTER A THROUGH EXAMINATION AND DIAGNOSIS
FOR A PREDICTABLE AESTHETICS

REFERENCES
1.TREATMENT PLANNONG OF IMPLANTS IN
AESTHETIC ZONE, BRITISH DENTAL JOURNAL, VOL 201,
NO-2, JUL 22 2006.
2. DEVELOPMENT OF SOFT TISSUE EMERGENCE
PROFILE: A TECHNIQUE, J PROSTHET DENT, 1994, 71,
364-368.

Treatment planning of implants/prosthodontic courses

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