Multidisciplinary Treatment Approach for Enhancement of Implant Esthetics

Multidisciplinary Treatment Approach for Enhancement of Implant Esthetics
March 2005
Wang, Hom-Lay DDS, MSD*; Shotwell, Jeffrey L. DDS, MSÇƒÜ; Itose, Tatsumasa DDSÇƒ?; Neiva, Rodrigo F. DDS, MS
Implant Dentistry: Volume 14
Abstract TOP
A team approach that includes different specialties from the initial stages of implant treatment is important to achieve predictable and esthetically pleasing outcomes in compromised dental replacement cases. This report describes a severely compromised case that was properly managed by the combined efforts of a team of specialists. Briefly, prior to tooth extraction, orthodontic forced eruption was applied to coronally displace the attachment apparatus (i.e., hard and soft tissues). Then, atraumatic tooth extraction together with immediate implant placement was performed. The sandwich bone augmentation technique was used to augment the deficient buccal alveolar ridge. A second stage surgery was performed 6 months after healing, revealing 100% of bone fill/augmentation. This technique allowed fabrication of a final restoration that respected the proportions of the natural dentition in a case that would otherwise result in a poor esthetic outcome.
Implant dentistry introduced a new paradigm in oral reconstruction. Replacement of missing teeth by means of endosseous dental implants has become an important and fundamental part of dentistry. Although techniques and materials have evolved that are capable of high success rates, the ultimate esthetic outcome is dependent not only on the materials and techniques applied but also on the efforts and collaboration among different dental specialties.
Several factors should be considered during treatment planning for achievement of optimal esthetics and function when tooth replacement by means of dental implants is indicated. Optimal occlusal schemes associated with adequate alveolar bone height, width, and quality are fundamental. Absence of one or more of these factors will inevitably compromise ideal implant placement, jeopardizing the final clinical outcome. Furthermore, the soft tissue profile is influenced largely by the underlying bone tissue.1-3 Correction of osseous deficiencies allow not only ideal implant placement but also creates more natural soft tissue profiles, influencing crown anatomy and consequently, esthetics. Hence, bone grafting may be a prerequisite for successful implant dentistry in select cases. Other important factors that must be addressed include morphology and displacement of adjacent teeth and the relationship of dental structures with other facial structures, such as the smile line. Only the combined efforts of multiple dental specialties can overcome such deficiencies.
The aim of the present report is to describe a significantly deficient case in which the combined work of orthodontics, periodontics, and prosthodontics was capable of reversing various negative factors, resulting in a highly esthetic outcome.
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