Implants in esthetic zone. / implant dentistry course/ implant dentistry course

Mohanad Al Sabbagh.ImplantsMohanad Al Sabbagh.Implants
in the esthetic zone.Dent Clinin the esthetic zone.Dent Clin
N Am 2006:50:391-407.N Am 2006:50:391-407.
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

 In the early years of modernIn the early years of modern
implantology ,the chief concern was tissueimplantology ,the chief concern was tissue
health and implant survival.health and implant survival.
 Over the last decade ,there has been anOver the last decade ,there has been an
increasing appreciation that esthetics isincreasing appreciation that esthetics is
just as important to the success of the finaljust as important to the success of the final
restoration as health.restoration as health.

 Challenging area for the clinician .Challenging area for the clinician .
 A subtle mistake Dissatisfaction.A subtle mistake Dissatisfaction.

 This article presents guide lines for idealThis article presents guide lines for ideal
implant positioning and for a variety ofimplant positioning and for a variety of
therapeutic modalities that can betherapeutic modalities that can be
implemented for addressing differentimplemented for addressing different
clinical situations.clinical situations.

 Diagnosis and treatment planning:Diagnosis and treatment planning:
 Preoperative assessment of patientsPreoperative assessment of patients
expectations.expectations.

 Gingival recession and biotypes:Gingival recession and biotypes:
 Determine risk for postsurgical recession.Determine risk for postsurgical recession.

 THIN SCALLOPEDTHIN SCALLOPED
PERIODONTIUMPERIODONTIUM
 Thin biotype requires the implant body and shoulder toThin biotype requires the implant body and shoulder to
be placed more palatally to mask any titanium showbe placed more palatally to mask any titanium show
through.through.
 Implant placed apically to avoid ridge lap design.Implant placed apically to avoid ridge lap design.
 A sub epithelial connective tissue graft.A sub epithelial connective tissue graft.
THICK,FLATTHICK,FLAT
PERIODONTIUMPERIODONTIUM..

 Interdental papilla:Interdental papilla:
 The distance between the underlyingThe distance between the underlying
interproximal bone height on the adjacentinterproximal bone height on the adjacent
natural teeth and the final prostheticnatural teeth and the final prosthetic
contact point dictates the formation andcontact point dictates the formation and
spontaneous regeneration of thespontaneous regeneration of the
interdental papillainterdental papilla

 Implant placement:Implant placement:
 Employ a conservative flap designEmploy a conservative flap design
 Evaluate the existing bone and soft tissueEvaluate the existing bone and soft tissue
 Time the placement correctlyTime the placement correctly
 Visualize the three dimensional position of theVisualize the three dimensional position of the
implant.implant.
 Consider healing time befor implant loadingConsider healing time befor implant loading
 Consider detrminants of emergence profile.Consider detrminants of emergence profile.
 Select a proper abutment and final restorationSelect a proper abutment and final restoration
design.design.

 Restoration driven implant placementRestoration driven implant placement
concept.concept.
 Optimal esthetic implant restorationOptimal esthetic implant restoration
depends on proper three dimensionaldepends on proper three dimensional
implant positioning.implant positioning.
 Four positional parameters contribute toFour positional parameters contribute to
the success of the restoration and must bethe success of the restoration and must be
carefully considered during implantcarefully considered during implant
placement.placement.

 Buccolingual position:Buccolingual position:
 Buccal dehiscenceBuccal dehiscence
restorationrestoration
Palatal ridge lapPalatal ridge lap
unhygienic,unestheticunhygienic,unesthetic
Buccal wall thickness 1mm to preventBuccal wall thickness 1mm to prevent
recession.recession.

Mesiodistal placementMesiodistal placement
 Improper mesiodistal positioning of implantsImproper mesiodistal positioning of implants
can have a substantial effect on the generationcan have a substantial effect on the generation
of interproximal papillary support as well as onof interproximal papillary support as well as on
the osseous crest of the adjacent teeth.the osseous crest of the adjacent teeth.
 It should be placed 1.5-2mm from an adjacentIt should be placed 1.5-2mm from an adjacent
tooth.tooth.
 In case of multiple implants ,a space of 3 toIn case of multiple implants ,a space of 3 to
4mm at the implant abutment level should be4mm at the implant abutment level should be
maintained between implants.maintained between implants.

Apico coronal position or counterApico coronal position or counter
sinksink
 Mask the metal of the implant and theMask the metal of the implant and the
abutment.abutment.
 Dependent on implant diameter.Dependent on implant diameter.
 ““running room”running room”
 If implant diameter smaller than cervix ofIf implant diameter smaller than cervix of
the tooth ,compensated by variablethe tooth ,compensated by variable
amount of running room.amount of running room.

 More the running room ,leads to microgapMore the running room ,leads to microgap
formation.formation.
 The sink depth of the implant shoulderThe sink depth of the implant shoulder
should be 1 to 2mm for one stage implantshould be 1 to 2mm for one stage implant
or 2-3mm for a two stage implant apicallyor 2-3mm for a two stage implant apically
to the imaginary line connecting midbuccalto the imaginary line connecting midbuccal
of CEJ’s of the adjacent teeth withoutof CEJ’s of the adjacent teeth without
gingival recession.gingival recession.

 Implant angulation:Implant angulation:

 Timing of implant placement followingTiming of implant placement following
tooth removal:tooth removal:
 According to Garber:According to Garber:
 Immediate placementImmediate placement
 Staged placement after 8 weeksStaged placement after 8 weeks
 Delayed placement after 3 months.Delayed placement after 3 months.

 Implant placement in edentulous sites:Implant placement in edentulous sites:
 Garber classification:Garber classification:
 Garber class 1:Garber class 1:

 So to achieve a successful esthetic resultSo to achieve a successful esthetic result
and good patient satisfaction ,implantand good patient satisfaction ,implant
placement in the esthetic zone demands aplacement in the esthetic zone demands a
thorough understanding of anatomicthorough understanding of anatomic
,biological,surgical and prosthetic,biological,surgical and prosthetic
principles.principles.

Thank you
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Implants in esthetic zone. / implant dentistry course/ implant dentistry course

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