Anterior implant-supported restorations: the aesthetic challenge

• Published in: Oral health Vol. 93; no. 4; p. 89
• Main Author: Karateew, E Dwayne
• Format: Magazine Article
• Language: English
• Published: Montréal Newcom Media Inc 01.04.2003
• Subjects: Cosmetic dentistry; Dental implants
• ISSN: 0030-4204

It is the preservation or reconstruction techniques utilized of this underlying osseous structure which eventually dictates the success or failure of the implant supported restoration from an aesthetic viewpoint.(5) The absence of adequate osseous structure lateral to implant fixture can result in black triangles between the teeth, soft tissue and prosthesis, thereby compromising aesthetics.(6) The labial gingival contour is supported and maintained by an adequate height and volume of labial bone. Although there exists techniques, which allow for alteration and amplification of deficient volumes of gingivae both interproximally and along the labial gingival contour, these surgical procedures alone may not provide sufficient bone for successful implantation. The osteotomy was performed to the appropriate depth, approximately 4-5 mm beyond the apex of the pre-existing tooth, and width, carefully preserving the integrity of the labial plate of bone. Primary implant stability was achieved by engaging the surrounding bone with the threads of the implant (Frialit-2, Friadent, Lakewood Co.). The implant itself was countersunk 6mm relative to the adjacent CEJ and 3mm relative to the surrounding osseous crest. The final implant angulation and mesio-distal placement was dictated by the extraction socket itself. The amount of tissue manipulation required post extraction varies between every case and is multifactorial in the decision algorithm. Aspects such as periodontal form, level of gingival tissues and the nature of the underlying osseous architecture surrounding the failing tooth often will directly influence the soft tissue response post surgery. If the tissue profile is less than ideal, then orthodontic and/or periodontal therapy may be necessary prior to implant placement.(4)(16) However, if the soft and hard tissue profile of the failing tooth is acceptable, then one may proceed with the implant placement, with the goal being maintenance of the existing tissue condition.(17)