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  • TREATMENT PLANNING OF IMPLANTS IN THE AESTHETIC ZONEINDIAN DENTAL ACADEMY

    Leader in continuing dental education www.indiandentalacademy.com

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  • INTRODUCTIONTHE PREDICTABILITY OF AESTHETIC SUCCESS DEPENDS ON THE TISSUE LOSS PRESENT AT THE INITIATION OF THE TREATMENTTHE GREATER THE BONE AND SOFT TISSUE LOSS, THE MORE DIFFICULT IT BECOMES TO PRODUCE AN IDEAL AESTHETIC RESULTSINGLE 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.

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  • PRIMARY OBJECTIVE: COMPLETE RECONSTRUCTION OF TOOTH AND GINGIVAL RELATED AESTHETICS.

    PREDICTABILITY: DEPENDS ON THE TISSUE LOSS PRESENT AT THE INITIATION OF TREATMENT.www.indiandentalacademy.com

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  • 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.

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  • 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.

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

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

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  • TOOTH POSITIONwww.indiandentalacademy.com

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  • APICO CORONAL POSITION:

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

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  • 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 www.indiandentalacademy.com

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  • 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.

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  • 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.www.indiandentalacademy.com

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  • Thin scalloped>15%DELICATE SOFT TISSUE CURTAINDEHISCENCE AND FENESTRATIONREDUCED QUALITY AND QUANTITY OF KERATINISED GINGIVA.REDUCED FACIALLY AND INTER PROXIMALLY WITH INSULT

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  • 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

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  • 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.www.indiandentalacademy.com

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  • 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.www.indiandentalacademy.com

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

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  • 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 PLACEMENTSHALLOW PLACEMENT OF AN IMPLANT RESULTING IN INADEQUATE SPACE FOR TRANSITION AND A SHORT RESTORATION IN LENGTH.www.indiandentalacademy.com

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  • 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.

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  • FACIO LINGUAL POSITIONTHE 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 TEETHwww.indiandentalacademy.com

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  • TWO ANATOMIC STRUCTURES ARE IMPORTANT IN DETERMINING THE PREDICTABILITY OF THE SOFT TISSUES AFTER IMPLANT PLACEMENT1. HEIGHT AND THE THICKNESS OF THE FACIAL BONE WALL AND2. BONE HEIGHT OF THE ALVEOLEAR CREST IN THE INTER PROXIMAL AREA.

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

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  • 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.

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  • IMPLANT POSITION

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  • 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.

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  • BUCCOLINGUAL POSITION:BUCCAL DEHISCENCE

    RESTORATIONPALATAL RIDGE LAP UNHYGIENIC, UNAESTHETIC BUCCAL WALL THICKNESS 1MM TO PREVENT RECESSION.www.indiandentalacademy.com

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  • MESIO-DISTALDECREASED PAPILLARY HEIGHTRESTORATIVE PROBLEMSPOOR EMBRASSURE FORM AND EMERGENCE PROFILELONG CONTACT ZONE

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  • 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

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  • TOO DEEP IMPLANT PLACEMENTDIFFICULTY IN IMPRESSION MAKINGDIFFICULTY IN INSTRUMENTATIONTISSUE IMPENGINGMENT

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  • CONSIDERATIONS FOR MULTIPLE IMPLANTS

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  • CONCLUSIONWHEN 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

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  • 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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