Prosthetic Management

Prosthetic Management of Implants in the Esthetic Zone
Frank Higginbottom, DDS1/Urs Belser, DMD2/John D. Jones, DDS3/Scott E. Keith, DDS, MS4
The purpose of this article is to review and project treatment procedures for areas of esthetic concern. The authors were participants in a consensus conference sponsored by ITI and held in August 2003 in Gstaad, Switzerland. This article deals with thebasic prosthetic/restorative aspects in implant esthetics. It is based on a literature review performed by 16 participants from Group 2 (Buser et al) in this section of the Journal. INT J ORAL MAXILLOFAC IMPLANTS 2004;19(SUPPL):62–72 Key words: dental implants, esthetics, implant abutments, implant diameter, provisional restorations

n esthetic area can be defined as any area to be restored thatis visible in the patient’s full smile. An esthetic implant restoration is one that resembles a natural tooth in all aspects.1–5 The position in which the implant is placed is of utmost importance, and the implant should be thought of as an extension of the clinical crown into the alveolar bone.6 This is only possible if the implant is correctly located in all 3 dimensions: apicocoronally,mesiodistally, and faciolingually. 1 Any deviation from these dimensions results in a problem the dental technician can scarcely solve. Choosing the appropriate time to place the implant into function

A

is the surgeon’s choice. The surgeon’s judgment precludes timetables and other potential standards.7,8

CONSIDERATIONS FOR ESTHETIC SITES
The restorative dentist needs to work with the surgeon,and both need to understand that certain principles are prerequisites for esthetic success.4,9–11 These may include but are not limited to the following: 1. The edentulous site must first exhibit adequate bone volume for the placement of a dental implant. If the site is deficient, there are many techniques that can be used for site development, some of which may be accomplished at time of implantplacement.12 In other instances it is best to augment the site in a separate procedure. 2. The placement position needs to be precise, as has been described in previous articles. 3. The abutment interface or connection needs to be stable. 4. The microgap between the implant and the abutment must be as small as possible.13

1Associate

Clinical Professor, Baylor College of Dentistry, Dallas,Texas. 2Professor and Chairman, Department of Prosthodontics, School of Dental Medicine, University of Geneva, Switzerland. 3Associate Professor, Department of Prosthodontics, University of Texas Health Science Center, San Antonio, Texas. 4Private Practice, San Francisco, California. Correspondence to: Dr Frank L. Higginbottom, 3600 Gaston, Suite 1107, Dallas, Texas 75246. Fax: +214-823-1370. E-mail:bottom@dallasesthetics.com

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Volume 19, Supplement, 2004

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Fig 1 Peri-implant space created around root-form dental implants.

Fig 2 Photograph of metal-ceramic implant-supported restorations in lateral incisor positions 7 years postplacement.

Fig 3 A flat gingival scallop in a mandibular posterior quadrant provides a shallow gingival crown margin interproximally.

Fig4 Anterior implant placement dictates deeper placement and a deep interproximal margin.

Fig 5 Multiple missing tooth gaps do not require an implant for each missing tooth.

Fig 6 Fixed partial denture replacing multiple missing teeth.

5. Esthetic restorations should be designed to have an approriate “emergence profile”14 and not a ridge lap. 6. The restoration should have the sameappearance as the adjacent teeth (Figs 1 and 2).

Implant Placement Considerations
Placement depth is an important aspect of an esthetic restoration. There must be good communication between the surgeon and the restorative clinician relative to proper implant positioning. In the posterior quadrants, where the gingival scallop is relatively flat, the implant shoulder may be at the gingival level or...