Reconstructive Aesthetic Implant Surgery.

Reconstructive Aesthetic Implant Surgery.
December 2003
Meffert, Roland M. DDS
Implant Dentistry: Volume 12(4) December 2003 p 275
Lippincott Williams & Wilkins
Reconstructive Aesthetic Implant Surgery. El Askary and Abd El Salam. Blackwell Munksgaard, 2003. ISBN: 0-8138-2108-8. 143 pgs.
This book addresses the surgical and reconstructive aspects of aesthetic dental implant restorations with a step-by-step clinical manual to aid the practitioner in achieving optimum clinical results. The author correctly points out that the days of compromise between providing the patient with function at the expense of appearance or aesthetics, or vice versa, is past, and this book attempts to point out that dental implantology requires artistic talent and clinical knowledge to provide a satisfactory result.
The first chapter addresses the important aspect of combining function and appearance or aesthetics. The implant patient of today is very concerned with aesthetics postimplant surgery, and restorative and single-tooth replacement with a dental implant in an aesthetic zone is a very common procedure. This chapter addresses the importance of presurgical planning and recognizing the relevance of peri-implant papillae and soft tissue contours in optimum cosmetics and aesthetics.
The second chapter concentrates on presurgical planning, using study casts, surgical templates. The chapter covers the important aspects of medical evaluation (any medical conditions that would render a patient incapable of maintaining adequate oral hygiene procedures, excessive smoking habits, any psychologic problems that would prohibit implant placement, allergies to the implant materials, and so on). The purpose of the study cast is outlined as the main diagnostic tool in the presurgical phase when used with a surgical template. Very importantly, the radiographic assessment is covered, using periapical, panoramic, computerized tomography (CT) techniques when and where needed. This chapter is very thorough in pointing out the needs and shortcomings of each radiographic technique and effectively covers what should be usedÇƒ?whenÇƒ?whereÇƒ?why in the field of radiographic assessment. Another aspect of presurgical planning in this chapter effectively covers treatment options. The patient presents at the dental office with a partially or fully edentulous mouth. The question immediately is, what are our treatment options? Options are covered in this chapter with rationale. A very important factor in presurgical planning is soft tissue quality and quantity. Aesthetics in the maxillary anterior region relies on healthy, keratinized soft tissue with good color and texture. The patient with a high smile or lip line will be very conscious of aesthetics, and the clinician must address this presurgically in the planning phase; the soft tissue must be evaluated to determine stage of health or disease. Finally, bone quantity and quality must be evaluated; the author classified bone according to the Misch divisions of: division A (abundant bone), division B (barely sufficient bone), division C (compromised bone), and division D (deficient bone). Today's surgical procedures address the techniques of grafting with auto-, allo-, or xenografts or alloplasts if adequate bone is not present for implant placement and stability. Again, dental implantology of today is a multidisciplinary procedure; the orthodontic and endodontic considerations are covered in the presurgical planning chapter.
The third chapter addresses dental implant anatomy, implant positioning on the alveolar ridge, and covers very well the implant designs of today that have new interface connections, new sizes, and new implant-related prosthetic components. Also, aesthetic implant positioning, mesiodistal positioning, labiopalatal positioning, apicoincisal positioning, and corrections of implant misplacement are covered in detail in this chapter.
The fourth chapter involves soft tissue management around dental implants. It is very extensive and very appropriate for the topic of aesthetics in implant therapy. What do we do before in terms of soft tissue management before implant placement? How do we handle soft tissue during implant placement? How do we handle soft tissue in delayed implant placement? How do we handle soft tissue in immediate implant placement? How do we handle soft tissue at the time of abutment connection? How careful do we have to be in limiting our incision in the keratinized tissues? When and where should we use soft tissue grafting? What are the rules for second-stage surgery? This chapter on soft tissue management is excellent in terms of the material covered, and the clinical photos presented for each question and problem are descriptive and relevant.
As to be expected, the fifth or final chapter covers aesthetic bone reconstruction and the means of grafting the alveolar ridge to attain optimal aesthetics. It is written by the only contributor to this text, Dr. Luc Huys. The repair process, mechanism of bone regeneration, the types and indications for use of bone grafting materials, and indications for regenerative barriers (both nonresorbable and resorbable) are covered in detail and effectively. I liked the conclusion in terms of the decision to use any particular grafting material to be based on defect size, properties and actions of the graft, required final result, and so on.
In my opinion, this book is an excellent reference to the topic of reconstructive aesthetic implant surgery, which is a major goal of today for both clinician and patient. Clinical photos are descriptive and relate well to the narrative of the book; references are current and valid.
¨© 2003 Lippincott Williams & Wilkins, Inc.