FOR DENTISTS: Critical Guidelines for Aesthetic Implant Success- Part 1

Restorative Dentistry

Implant restoration in the aesthetic zone can be a challenging but rewarding task. Unlike posterior implant restorations, aesthetic zone implants need to restore not only function, but form and appearance as well.

Successful aesthetic zone implant cases require a collaborative effort between the implant surgeon and the restorative dentist. In this month’s article, we share two keys to achieving a more predictable treatment outcome.

Proper Initial Diagnosis

This is essential for aesthetic implant restorations. An image of what the final outcome would look like prior to treatment is an important factor for success.

Intraoral and extraoral photos should be taken to evaluate factors including extraoral features, and restoration shade and translucency that impressions can’t provide.

Cone beam should be used routinely to evaluate the amount of available bone. This is especially critical in determining whether immediate or staged implant surgery would be performed. Often, guided surgery will be used to enhance the surgical and prosthetic outcome.

Gingival symmetry and zenith of adjacent teeth should be evaluated and matched as necessary. Clinical crown length of adjacent teeth also is an important factor in determining the length of the implant-supported restoration. In cases where gingival disharmony is expected, additional grafting or resective procedures should be performed in conjunction with implant surgery. This also holds true in cases of thin tissue biotype where soft tissue augmentation is indicated to avoid future recession around implant.

Bone profile must be kept in mind. Facial bone tends to be thin in maxillary anteriors, and thin tissue profile is more prone to recession long-term. Consider use of overlay graft or soft tissue grafts to convert the biotype.

Restorative considerations

Abutment design should have negative contour in subgingival area to provide proper soft tissue support, but not displace the tissue apically. This information must be specifically requested from your lab during the CAD/CAM design phase, otherwise abutments return overcontoured.

Clinically during abutment insertion, tissue blanching indicates a non-passive fit with excess pressure exertion. This embarrassment to the tissues should be avoided through careful abutment design and tissue management.

Clinical photography is the only effective way to communicate final shade mapping and crown contours to your lab partner.

Consider the use of zirconium abutment over the metal counterpart. Zirconium abutments provide strength with superior abutment-implant interface that harbor less bacterial colonization. Long-term aesthetic problems such as tissue discoloration and recession also are less likely.

Finally, use a metal free restorative material such as emax. Pfm margins will show a gray discoloration as the tissue changes over the years, creating an aesthetic dilemma.

Stay tuned for part two of this topic, where we will share four more keys to achieving more predictable treatment outcomes.

Meet Dr. D

Dr. David DiGiallorenzo received his training at the University of Pennsylvania in the Department of Periodontics and Periodontal Prosthesis in the early 1990s. His training included prosthodontics, orthodontics, periodontics, and advanced oral reconstructive techniques, including oral implantology.

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