J Dent Rehabil Appl Sci.  2021 Dec;37(4):186-198. 10.14368/jdras.2021.37.4.186.

Esthetic considerations for anterior implant-supported prostheses: focus on surgical and prosthetic treatment

• Park YH
• Ahn SG
• Kim KA
• Seo JM

• KMID: 2525993
• DOI: http://doi.org/10.14368/jdras.2021.37.4.186

Abstract

As the increased certainty of osseointegration, new parameters are now being used to assess implant success. Accordingly, patients’ and clinicians’ high demands and expectation for esthetics have expanded and implant-supported restorations show better esthetic outcomes. The pre-implant treatment planning process, the implant surgical steps and the post-surgery prosthetic process can affect all esthetic outcomes. Prevention of esthetic implant failures can be achieved by appropriate treatment at each stage, considering the 3 factors of alveolar bone, soft tissue, and implants. It is necessary to achieve the esthetic implant prostheses followings: minimal invasive surgery, bone augmentation, ideal 3-dimensional implant position, peri-implant soft tissue management, and provisional restorations to optimize peri-implant soft tissue architecture.

Keyword

dental implant; dental esthetics; dental prosthesis; implant-supported; marginal gingiva; interdental papilla

Figure

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  Fig. 1 Unesthetic long crown resulting from excessive depth of implant placement in atrophic alveolus.

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  Fig. 2 Even the implant with platform switching, more apically placed implants cannot prevent bone resorption above the platform. This could lead to a marginal gingiva recession.

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  Fig. 3 Shallow implant placement. (A) Natural teeth. (B) Extraction. (C) Bone healing. (D) Palatal placement of narrow implant.

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  Fig. 4 Optimal implantation depth. (A) Marginal gingiva ~ buccal bony crest ≈ 3 - 4 mm. (B) Interproximal bony crest ~ buccal bony crest ≈ 3 - 4 mm. (C) Interproximal contact (interdental papilla) ~ interproximal bony crest ≤ 5 mm.

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  Fig. 5 Implant position and angle of implant inclination. (A) Delayed implantation - buccal bone thickness of 1.8 mm or more at the level of the implant shoulder. (B) Symmetry of gingival zenith of implant and natural teeth. (C) Immediate implantation after extraction - facial bone wall at least 1 mm in thickness and minimum distance of 2 mm between the implant platform and the inner surface of the facial socket wall.

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  Fig. 6 Buccolingual inclination of implant. (A) Buccal implant inclination leads to long crown in relation to ideal implant position. (B) Too buccally angulated implant have apically positioned screw access hole: midfacial gingival recession.

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  Fig. 7 Creeping effect. Gingival height/width: natural teeth - 1.5/1.0, implant - 1.0/1.5.

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  Fig. 8 Platform switching is advantageous in peri-implant soft tissue preservation by having thicker gingiva.

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  Fig. 9 The effect of abutment shape. (A) Convex shape - thinner gingiva. (B) Flat shape. (C) Concave shape - thicker gingiva.

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  Fig. 10 Altering the facial contour of the implant crown. (A) An implant crown should have the same incisogingival heght (H) as the original tooth. (B) Correctly contoured implant crown (h = longer crown height). (C) Incorrectly contoured implant crown (arrow: trapping food and creating esthetically unacceptable shadow).

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  Fig. 11 A digital technique for replicating provisional restoration. (A) Surface architecture with provisional restoration in place. (B) Peri-implant mucosa. (C) Implant position. (D) Emergence profile of interim prosthesis. (E) A, B, C, and D superimposed to generate impression with implant position, peri-implant mucosa, and emergence profile. (F) Definitive restoration.

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  Fig. 12 Interdental papilla of multiple implants. (A) Crestal placement of implants-lower interdental papilla. (B) Subcrestal placement of implants-higher inderdental papilla, but longer crown.

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  Fig. 13 Inter-implants distance.

Reference

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