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TREATMENT PLANNING OF IMPLANTS IN THE AESTHETIC ZONE

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

INTRODUCTIONTHE PREDICTABILITY OF AESTHETIC SUCCESS

DEPENDS ON THE TISSUE LOSS PRESENT AT THE INITIATION OF THE TREATMENT

THE GREATER THE BONE AND SOFT TISSUE LOSS, THE MORE DIFFICULT IT BECOMES TO PRODUCE AN IDEAL AESTHETIC RESULT

SINGLE TOOTH IMPLANTS HAVE A HIGH DEGREE OF PREDICTABILITY AS THE ADJACENT TEETH PROVIDES THE MORPHOLOGICAL SUBSTRUCTURE THAT IS REQUIRED TO RESTORE THE NATURAL GINGIVAL AND PAPILLARY ARCHITECTURE.

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DIAGNOSIS AND APPROPRIATE TREATMENT PLANNING ARE CRITICAL IN OBTAINING A SUCCESSFUL OUTCOME.



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BONE RESORPTION FOLLOWING ANTERIOR TOOTH EXTRACTION OFTEN COMPROMISES GINGIVAL TISSUE LEVELS FOR THE IMPLANT SUPPORTED RESTORATIONS.


PRIMARY OBJECTIVE: COMPLETE RECONSTRUCTION OF TOOTH

AND GINGIVAL RELATED AESTHETICS.

PREDICTABILITY: DEPENDS ON THE TISSUE LOSS PRESENT AT

THE INITIATION OF TREATMENT.


DIAGNOSIS AND TREATMENT PLANNING PLAY A VERY IMPORTANT ROLE FOR A SUCCESSFUL OUTCOME.

TREATMENT PLANNIG MUST ADDRESS HARD AND SOFT TISSUE DEFICIENCIES AND COMBINE THIS WITH PRECISION IN IMPLANT PLACEMENT.


FACTORS AFFECTING AESTHETIC OUTCOME .PATIENT SELECTION AND SMILE LINE.TOOTH POSITION.ROOT POSITION OF THE ADJACENT TEETH.BIOTYPE OF THE PERIODONTIUM AND

TOOTH SHAPE.THE BONY ANATOMY OF IMPLANT SITE.THE POSITION OF THE IMPLANT.


PATIENT SELECTION AND SMILE LINE.PATIENT DESIRES.BENEFITS OF IMPLANT RESTORATION.ADDITIONAL LENGTH OF TIME.ADDITIONAL COST.


PATIENTS AESTHETIC EXPECTATIONS MUST BE EVALUATED TOGETHER WITH THERE LIP ACTIVITY AND LIP LENGTH.


TOOTH POSITION

TOOTH POSITION

APICOCORONAL FACIOLINGUAL MESIODISTAL


APICO CORONAL POSITION:

THE GINGIVAL MARGIN OF TOOTH TO BE EXTRACTED FOR IMMEDIATE PLACEMENTMUST BE EVALUATED.


MESIODISTAL POSITION:

IDEALLY THE MESIODISTAL TOOTH WIDTH SHOULD BE EQUAL TO THE WIDTH OF THE CONTRALATERAL TOOTH FOR AN GOOD AESTHETICOUTCOME.

EXCESSIVE MESIO DISTAL SPACE IN THE REGION REQUIRING IMPLANT RESTORATION.

RESTORATION RESULTING WITH ABSENCE OF INTERDENTAL PAPILLA


ROOT POSITION OF THE ADJACENT TEETH.TEETH WITH ROOT PROXIMITY OFTEN

PRECLUDES PLACING OF IMPLANTS. THE THIN BONE PRESENT CREATES A GREATER RISK OF LATERAL RESORPTION LEADING TO DECREASE IN THE VERTICAL BONE HEIGHT AFTER EXTRACTION OR IMPLANT PLACEMENT.


BIOTYPE OF PERIODONTIUM AND TOOTH SHAPE.

THIN SCALLOPED PERIODONTIUM

THIN BIOTYPE REQUIRES THE IMPLANT BODY AND SHOULDER TO BE PLACED MORE PALATALLY TO MASK ANY TITANIUM SHOWTHROUGH.

THICK,FLAT PERIODONTIUM.


Thin scalloped>15%DELICATE SOFT TISSUE CURTAINDEHISCENCE AND FENESTRATIONREDUCED QUALITY AND QUANTITY OF

KERATINISED GINGIVA.REDUCED FACIALLY AND INTER PROXIMALLY

WITH INSULT


THICK FLATDENSER MORE FIBROTIC SOFT TISSUE

CONTOURINCREASED QUALITY AND QUANTITY OF THE

KERATNISED MUCOSAPOCKET FORMATION WITH INSULTCONTACT AREAS ARE LOCATED MORE

TOWARDS THE MIDDLE THIRD OF THE TOOTH


IDEALLY THE FACIAL CONTOUR SHOULD BE SLIGHTLYFLATTER THAN THE CONTRALATERALNATURAL TOOTH TO MINIMISE APICAL

DISPLACEMENT OF THE FREE GINGIVAL MARGIN AFTER INSERTION.

OVER CONTOURING OF IMPLANT PROVISIONAL RESTORATION AS IT EMERGES FROM THE FREE GINGIVAL MARGIN RESULTING IN APICAL MIGRATION OF THE SOFT TISSUES.


BONY ANATOMY OF IMPLANT SITE.

BONY ANATOMY OF THE SITE MUST HAVE A THREE DIMENSIONAL CONFIGURATION THAT PERMITS PLACEMENT OF THE IMPLANT IN RESTORATIVELY IDEAL POSITION.

BONE GRAFTING IS ADVISED IN CASE OF ANY INADEQUACIES.

INADEQUATE BUCCOLINGUAL WIDTH FOR IMPLANT PLACEMENT.


IMPLANT POSITION

IMPLANT SHOULD BE PLACED SUCH THAT IT ALLOWS THE MAINTENANCE OF BOTH HARD AND SOFT TISSUE ARCHITECTURE.

Implantposition

Apicocoronalplacement

Mesiodistalplacement

Faciolingual Placement.


•APICOCORONAL PLACEMENT

IMPLANT SHOULD BE PLACED 3-4mm APICAL TO THE EXISTING

FREE GINGIVAL MARGIN. ADEQUATE ROOM IS REQUIRED FOR THE TRANSITION FROM THE HEAD OF THE IMPLANT TO THE

POINT WHERE THE RESTORATION EXITS THE FREEGINGIVAL MARGIN.

IDEAL PLACEMENT

SHALLOW PLACEMENT OF AN IMPLANT RESULTING IN INADEQUATE SPACE FOR TRANSITION AND A SHORT RESTORATION IN LENGTH.


MESIODISTAL PLACEMENTIMPROPER MESIODISTAL POSITIONING OF

IMPLANTS CAN HAVE A SUBSTANTIAL EFFECT ON THE GENERATION OF INTERPROXIMAL PAPILLARY SUPPORT AS WELL AS ON THE OSSEOUS CREST OF THE ADJACENT TEETH.

IT SHOULD BE PLACED 1.5-2mm FROM AN ADJACENT TOOTH.


FACIO LINGUAL POSITION

THE AMOUNT OF AVAILABLE BONE SHOULD BE ATLEAST 1mm GREATER THAN THE IMPLANT DIAMETER ON EACH SIDE.

IDEAL IMPLANT PLACEMENT SHOULD BE PALATAL TO AN IMAGINARY LINE THAT OUTLINES THE CURVATURE OF THE TEETH


TWO ANATOMIC STRUCTURES ARE IMPORTANT IN DETERMINING THE PREDICTABILITY OF THE SOFT TISSUES AFTER IMPLANT PLACEMENT

1. HEIGHT AND THE THICKNESS OF THE FACIAL BONE WALL AND

2. BONE HEIGHT OF THE ALVEOLEAR CREST IN THE INTER PROXIMAL AREA.


. HEIGHT AND THE THICKNESS OF THE FACIAL BONE WALLTHIS WAS BASED ON THE VERTICAL

DISTANCE OF THE OSSEOUS CREST TO THE FREE GINGIVAL MARGIN.

THE GREATER THE DISTANCE THE GREATER WILL BE THE RISK AFTER AN INVASIVE PROCEDURE

MEASURING THIS HEIGHT BEFORE AN EXTRACTION WILL HELP US ANTICIPATE THE FINAL POSITION OF THE FREE GINGIVAL MARGIN


BONE HEIGHT OF THE ALVEOLEAR CREST IN THE INTER PROXIMAL AREA.THIS PLAYS AN IMPORTANT ROLE IN THE

PRESENCE OR ABSENCE OF PERI-IMPLANT PAPILLAE.


IMPLANT POSITION


RESTORATION DRIVEN IMPLANT PLACEMENT CONCEPT.

OPTIMAL ESTHETIC IMPLANT RESTORATION DEPENDS ON PROPER THREE DIMENSIONAL IMPLANT POSITIONING.

FOUR POSITIONAL PARAMETERS CONTRIBUTE TO THE SUCCESS OF THE RESTORATION AND MUST BE CAREFULLY CONSIDERED DURING IMPLANT PLACEMENT.


BUCCOLINGUAL POSITION:BUCCAL DEHISCENCE RESTORATIONPALATAL RIDGE LAP UNHYGIENIC, UNAESTHETIC BUCCAL WALL THICKNESS 1MM TO PREVENT

RECESSION.


MESIO-DISTALDECREASED PAPILLARY HEIGHTRESTORATIVE PROBLEMSPOOR EMBRASSURE FORM AND

EMERGENCE PROFILELONG CONTACT ZONE


APICO CORONALERRORS IN APICO CORNAL IMPLANT

PLACEMENT CAN HAVE SERIOUS AESTHETIC AND BIOMECHANICAL IMPLICATIONS.

AN IMPLANT PLACED TOO CORONALLY WILL ALLOW ADEQUATE TRANSITION FROM THE HEAD OF THE IMPLANT TO THE POINT WHERE THE RESTORATION EXITS FROM THE FREE GINGIVAL MARGIN


TOO DEEP IMPLANT PLACEMENTDIFFICULTY IN IMPRESSION MAKINGDIFFICULTY IN INSTRUMENTATIONTISSUE IMPENGINGMENT


CONSIDERATIONS FOR MULTIPLE IMPLANTS


CONCLUSION

WHEN A PATIENT HAS A MISSING ANTERIOR TEETH AND DESIRES REPLACEMENT, ADECISSION SHOULD BE MADE WHETHER HE HAS TO GO FOR A BRIDGE OR AND IMPLANT OR A RESIN BONDED PROSTHESIS AFTER A THROUGH EXAMINATION AND DIAGNOSIS FOR A PREDICTABLE AESTHETICS


REFERENCES1.TREATMENT PLANNONG OF IMPLANTS IN

AESTHETIC ZONE, BRITISH DENTAL JOURNAL, VOL 201, NO-2, JUL 22 2006.

2. DEVELOPMENT OF SOFT TISSUE EMERGENCE PROFILE: A TECHNIQUE, J PROSTHET DENT, 1994, 71, 364-368.



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Download - Treatment planning of dental implants /orthodontic courses by Indian dental academy

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