Modificacion del tejido dentario

CLINICAL APPLICATION

Joseph Y K Kan, DDS, MS
Professor, Department of Restorative Dentistry, Advanced Education in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, California, USA

Kitichai Rungcharassaeng, DDS, MS
Associate Professor, Department of Orthodontics and Dentofacial Orthopedics, Loma Linda University School of Dentistry, Loma Linda, California, USAMichael Fillman, DDS, MS
Associate Professor, Department of Orthodontics and Dentofacial Orthopedics, Loma Linda University School of Dentistry, Loma Linda, California, USA

Joseph Caruso, DDS, MS, MPH
Chair and Associate Professor, Department of Orthodontics and Dentofacial Orthopedics, Loma Linda University School of Dentistry, Loma Linda, California, USA

Correspondence to: Dr Joseph KanCenter for Prosthodontics and Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA 92354, U.S.A; phone: (011) 1-909-558-4980; fax: (011) 1-909-558-4803; e-mail: jkan@.llu.edu

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THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 4 • NUMBER 2 • SUMMER 2009

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Tissue Architecture Modification for Anterior Implant Esthetics: An Interdisciplinary Approachpyrig No Co t fo rP ub lica tio n te ss e n c e

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Replacing multiple adjacent failing teeth with compromised osseous and gingival architecture with implants in the esthetic zone is often challenging and demanding for the clinician. Multiple procedures are usually required and entail a preservation technique, a re-creation approach, or a combination of both. Thisarticle describes

an interdisciplinary approach (orthodontics, periodontics, and prosthodontics) for tissue architecture modification in multiple adjacent failing teeth with osseous and gingival tissue discrepancies in the esthetic zone. The rationale and limitations are also discussed. (Eur J Esthet Dent 2009;4:104–117.)

THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY VOLUME 4 • NUMBER 2 • SUMMER2009

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Abstract

KAN ET AL pyrig No Co t fo rP ub lica tio n te ss e n c e

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CLINICAL APPLICATION

a low crest osseous–gingival tissue relaIn recent years, achieving optimal implant esthetics has been the Holy Grail of implant dentistry. As the peri-implant tissue architecture is the essence of the implant esthetics, techniques have been devised topreserve and/or re-create its natural form. To replace failing anterior maxillary teeth, the preservation technique (immediate implant placement and provisionalization) is usually the preferred method.
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tionship facially (> 3 mm), and interproximally (> 4.5 mm) of the immediate adjacent dentition (teeth 8 and 11).7-9 The periapical radiograph displayed severe localized periodontal boneloss around the maxillary left central and lateral incisors (teeth 9 and 10), but with no periapical radiolucency (Fig 2). Upon occlusal examination, an excessive anterior vertical overlap (80%) was observed. In addition, a low incisal position of maxillary incisors and average gingival exposure were evident during smile analysis (Fig 3).10 The patient was advised that teeth 9 and 10 were hopelessand required extraction. The patient requested that the failing teeth be replaced with implant-supported restorations. The patient also expressed the desire to improve overall dental esthetics in the anterior region. After a thorough diagnosis and planning, a comprehensive treatment plan that addressed all the patient’s concerns was devised. The treatment sequence entailed: (1) tissuearchitecture modification with orthodontic and periodontal interven-

Nevertheless, it

is indicated only with the presence of ideal pre-existing tissue conditions; eg, an appropriate gingival level and osseous-gingival relationship. When tissue discrepancy is apparent, a re-creation approach, which entails periodontal and/or orthodontic intervention, might be required.4-6 This article describes an...