Implant Therapy in the Esthetic Zone

Single-Tooth Replacements

Daniel Buser, Urs C. Belser, Daniel Wismeijer, Daniel Buser, Urs C. Belser, Daniel Wismeijer

• Publisher: Quintessence Publishing
• Year: 2019
• Edition: 1
• eBook ISBN:
  9781850973430
• Topic: Medicine
• Subtopic: Dentistry

This first volume focuses on implant therapy for single-tooth replacement in the esthetic zone. It guides readers through the entire treatment process, beginning with assessment of the patient's individual esthetic risk profile and proceeding through ideal three-dimensional implant placement and proven prosthetic management options. Various procedures are illustrated through patient case studies. Detailed illustrations serve to clarify any potential ambiguities, and potential complications are explored to avert the most common problems.The ITI Treatment Guide series, a compendium of evidence-based implant therapy techniques employed in daily practice, offers a comprehensive overview of various therapeutic options. Written by expert clinicians of worldwide renown and using an illustrated step-by-step approach, the ITI Treatment Guide shows practitioners how to manage different clinical situations, emphasizing sound diagnostics, evidence-based treatment concepts, and predictable treatment outcomes throughout.

1   Introduction

D. Buser, U.C. Belser, D. Wismeijer

Over the past 15 years, implant dentistry has progressed faster than many other disciplines in dental medicine. Whereas osseointegration was the primary goal two decades ago, it is nowadays taken for granted and implants are expected to remain functional for decades.

The success of implant therapy is no longer judged mainly by the osseointegration of the implant. In recent years, esthetics has become an inseparable part of oral rehabilitation as patients not only expect implant-supported restorations to be functional long-term, but also to be esthetic, especially in regions of the oral cavity that are visible when the patient smiles.

Supported by new academic curricula as well as by statements from clinical dentistry, such as the Proceedings of the Third ITI Consensus Conference published in a special 2004 supplement of JOMI, we believe that we are coming closer to creating the “perfect illusion” and maintaining it over time.

This is on one hand due to our increased knowledge of biological principles such as biologic width. On the other hand, our increasing awareness of the implementation of biomimetic principles, derived from a growing understanding of the key anatomic and optical parameters of the natural dentition, supports this goal as well.

Nevertheless, predictable optimum results in the esthetic region can only be achieved through application of a comprehensive clinical concept based on experience, sound pre-operative examination and treatment planning, and a team approach that unites patients, surgeons, prosthodontists, and dental technicians.

It is logical to use the 2004 Consensus Proceedings for drawing up and publishing detailed clinical guidelines regarding diagnosis, treatment planning, and the management of patients requiring implant therapy in the esthetic zone.

Sound, evidence-based clinical concepts that produce successful treatment outcomes are needed.

The present first volume of the ITI treatment guide provides comprehensive details on all aspects of implant therapy in the esthetic zone.

2 Proceedings of the Third ITI Consensus Conference: Esthetics in Implant Dentistry

The International Team for Implantology (ITI) is a nonprofit academic organization of professionals in implant dentistry and tissue regeneration with over 2000 fellows and members in more than 40 countries. The ITI organizes consensus conferences at 5-year intervals to discuss relevant topics in implant dentistry.

The first and second ITI Consensus Conferences in 1993 and 1997 (Proceedings of the ITI Consensus Conference 2000) primarily discussed basic surgical and prosthetic issues in implant dentistry. For the Third ITI Consensus Conference in 2003, the ITI Education Committee decided to focus the discussion on four special topics that had received much attention in recent years, “Esthetics in Implant Dentistry” being one of them (Proceedings of the Third ITI Consensus Conference, published in 2004).

A working group was elected for the exploration of each topic. Working Group 2, exploring the topic of “Esthetics in Implant Dentistry,” consisted of the following ITI fellows:

Group leader: Urs C. Belser

Participants: Daniel Buser
Jean-Paul Martinet Douteau
Javier G. Fabrega
Timothy W. Head
Joachim S. Hermann
Frank L. Higginbottom
John D. Jones
Hideaki Katsuyama
Scott E. Keith
William C. Martin
Stephen Rimer
Johannes Röckl
Bruno Schmid
Alwin Schönenberger
David Shafer
Christian ten Bruggenkate
Dieter Weingart

The group was asked to arrive at a consensus position related to the esthetic dimension of implant dentistry in the anterior maxilla, based on its discussion of and subsequent deliberation on three position papers that had been prepared regarding the following fields:

1. Outcome analysis of implant restorations located in the anterior maxilla
2. Anatomical and surgical considerations of implant therapy in the anterior maxilla
3. Practical prosthodontic procedures related to anterior maxillary fixed implant restorations

The subsequent text gives an overview of the consensus statements developed by the group (Belser and coworkers, 2004).

2.1 Consensus Statements and Recommended Clinical Procedures Regarding Esthetics in Implant Dentistry

In esthetic dentistry, difficulties arise in generating evidence-based statements regarding clinical procedures. Therefore, any clinical recommendations given with regard to esthetics in implant dentistry are primarily based on the expert opinion of the Esthetics consensus group. The group worked on each statement until a unanimous opinion was reached.

2.1.1 Statements A: Long-Term Results

Statement A.1

Evidence from the Literature

The use of dental implants in the esthetic zone is well documented in the literature. Numerous controlled clinical trials show that the respective overall implant survival and success rates are similar to those reported for other segments of the jaws. However, most of these studies do not include well-defined esthetic parameters.

Statement A.2

Single-Tooth Replacement

For anterior single-tooth replacement in sites without tissue deficiencies, predictable treatment outcomes, including esthetics, can be achieved because tissue support is provided by adjacent teeth.

Statement A.3

Multiple-Tooth Replacement

The replacement of multiple adjacent missing teeth in the anterior maxilla with fixed implant restorations is poorly documented. In this context, esthetic restoration is not predictable, particularly regarding the contours of the interimplant soft tissue.

Statement A.4

Newer Surgical Approaches

Currently, the literature regarding esthetic outcomes is inconclusive for the routine implementation of certain surgical approaches, such as flapless surgery and immediate or delayed implant placement with or without immediate loading in the anterior maxilla.

2.1.2 Statements B: Surgical Considerations

Statement B.1

Planning and Execution

Implant therapy in the anterior maxilla is considered an advanced or complex procedure and requires comprehensive preoperative planning and precise surgical execution based on a restoration-driven approach.

Statement B.2

Patient Selection

Appropriate patient selection is essential in achieving esthetic treatment outcomes. Treatment of high-risk patients identified through site analysis and a general risk assessment (medical status, periodontal susceptibility, smoking, and other risks) should be undertaken with caution, since esthetic results are less consistent.

Statement B.3

Implant Selection

Implant type and size should be based on site anatomy and the planned restoration. Inappropriate choice of implant body and shoulder dimensions may result in hard and/or soft tissue complications.

Statement B.4

Implant Positioning

Correct three-dimensional implant placement is essential for an esthetic treatment outcome. Respect of the comfort zones in these dimensions results in an implant shoulder located in an ideal position, allowing for an esthetic implant restoration with stable, long-term peri-implant tissue support.

Statement B.5

Soft-Tissue Stability

For long-term esthetic soft-tissue stability, sufficient horizontal and vertical bone volume is essential. When deficiencies exist, appropriate hard and/or soft-tissue augmentation procedures are required. Currently, vertical bone deficiencies are a challenge to correct and often lead to esthetic shortcomings. To optimize soft-tissue volume, complete or partial coverage of the healing cap/implant is recommended in the anterior maxilla. In certain situations, a non-submerged approach can be considered.

2.1.3 Statements C: Prosthodontic and Restorative Procedures

Statement C.1

Standards for an Esthetic Fixed Implant Restoration

An esthetic implant prosthesis was defined as one that is in harmony with the peri-oral facial structures of the patient. The esthetic peri-implant tissues, including health, height, volume, color, and contours, must be in harmony with the healthy surrounding dentition. The restoration should imitate the natural appearance of the missing dental unit(s) in color, form, texture, size, and optical properties.

Statement C.2

Definition of the Esthetic Zone

Objectively, the esthetic zone was defined as any dento...

Table of contents

• Deckblatt
• Titelblatt
• Copyright-Seite
• Inhaltsverzeichnis
• Preface
• Acknowledgment
• Editors and Authors
• 1 Introduction
• 2 Proceedings of the Third ITI Consensus Conference: Esthetics in Implant Dentistry
• 3 Pre-operative Analysis and Prosthetic Treatment Planning in Esthetic Implant Dentistry
• 4 Achieving Optimal Esthetic Results
• 5 Esthetic Complications and Their Causes
• 6 Synopsis
• Literature/References
• Decision tree 1 (chapter 4.3 and 4.3.1)
• Decision tree 2 (chapter 4.3 and 4.3.2)