A Multidisciplinary Approach to Enhance Implant Esthetics: Case Report

A Multidisciplinary Approach to Enhance Implant Esthetics: Case Report
Implant Dentistry: Volume 12(1) March 2003 pp 18-23
El Salam El Askary, Abd BDS*
*Private practice, Alexandria, Egypt; Assistant Clinical Professor, University of Florida.
The author claims to have no financial interest in any company or any of the products mentioned in this article.
Lippincott Williams & Wilkins.
Abstract
Esthetic implant-supported restorations in the anterior maxilla present a number of clinical challenges to the dentist, including the need to preserve or restore the periimplant hard and soft tissue architecture around the implant site. In this clinical case report, two implant systems were used to restore two missing maxillary central incisors to make use of the physical properties in each system. Two different surgical protocols were used to place each implant, and the deficient alveolar bone was restored with an autogenous bone graft. After a detailed clinical evaluation, a comprehensive treatment plan was developed to address the unique demands of the patient. Both teeth were fully restored with esthetic, implant-supported, single-tooth restorations, and clinical results were recorded postoperatively.
The successful fabrication of an implant-supported restoration in the esthetic zone requires an accurate diagnosis and treatment plan. Soft tissue management is one of many factors that greatly impact the final esthetic result, with the need to harmonize color, form, and contour with that of the adjacent tissues. 1-2 To accurately replicate the soft tissue contours and natural tooth position in cases where postextraction bone resorption, anatomical limitations, or periodontal diseases have diminished the volume of available alveolar bone, 3-4 it may be necessary to first reconstitute the lost supporting hard tissue structure to its original size by bone grafting in a staged treatment approach. 1,5-6 In cases where simple dehiscences or small vertical defects are present, and the remaining bone can provide primary stabilization for the implant fixture, bone augmentation procedures may often be performed at the time of implant surgery in a nonstaged approach. 6
Some clinicians have advocated the immediate placement of dental implants into prepared extraction sockets to preserve the contour and dimensions of the alveolar ridge after tooth extraction. 7-11 Prerequisites for immediate implant placement include the atraumatic removal of the unsalvageable tooth, sufficient bone quantity to achieve good primary stability for the implant fixture, absence of any pathological lesion or soft tissues in the socket, and use of the appropriate implant diameter and design (for example a tapered design) that corresponds to the width, angle, and position of the prepared socket. Although immediately placed implants have reportedly achieved osseointegration success rates comparable to implants inserted into healed sites, 12-14 the problems associated with the inability to achieve primary soft tissue closure have often not been adequately addressed. Failure to achieve primary closure on top of immediate implants placed in fresh extraction sites can result in postoperative infection and/or loss of the graft material. Other researchers have also recommended caution in the placement of wide-diameter implants in esthetically demanding areas that minimize postrestorative, soft tissue recession. 15
The volume, shape, quality, and quantity of available bone in the esthetic zone differ among patients, as do the implant designs, sizes, surfaces, and surgical protocols that are available to treat them. Successful, esthetic implant restorations in the anterior maxillary jaw thus require an individualized approach based on the functional, anatomical, psychological, and esthetic needs of the patient. 16-17 This article reports on two implant systems with two different surgical protocols.
Please visit the web site to view the article in its entirety.