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single tooth
replacementSCE
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outline
Posterior tooth replacement
Tooth replacement in Esthetic zone
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Posterior tooth replacement
Treatment option
fixed partial denture
removable partial denture
implant fixed restoration
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Posterior tooth replacement
review patient medical history for
diseases
medication e.g. osteoporosis drug,
anticoagulant, etc.allergy e.g. penicillin
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Posterior tooth replacement
previous dental history as an information
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Posterior tooth replacement
take radiographs and impressions
mounted casts in articulator
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Posterior tooth replacement
measurements can be made; M-D, B-L, O-C
distances
3
Minimum gap width 6.8 mm
At least 1 mm
Implant shoulder
4.8 mm At least 1 mm
I l
l
I
l l
l
l
I - l l
l l
l
Bone layerat least1 mm in thickness
Implant shoulder
Bone layerat least1 mm in thickness
implant diameter+ at least 1mm from the contact point (M-D) at least 1 mm on each side (B-L)
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Posterior tooth replacement
minimum vertical clearance for abutment
height + thickness of the restorations
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Posterior tooth replacement
wax up tooth can be made for surgical guide
preparation
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Posterior tooth replacement
before implant surgery: potentialcomplications are reviewed, a need for bone/
soft tissue grafts, flap design, type of cover
screw and suture
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Posterior tooth replacement
implant surgery visit: inform patient aboutpost-op pain and instruction, prescribe pain
medication and/or antibiotics and mouthrinse
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Posterior tooth replacement
follow-up visit and suture removal
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Posterior tooth replacement
impression taking; for abutment level
impression option provisional crown or
protective cap was placed on the abutment.
for implant level impression, cover screw is
placed back on an implant.shade selection
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single tooth replacement in the
esthetic zone
Consensus Statement and Recommended Clinical
Procedures Regarding Esthetics in Implant Dentistry
Statement A.1: evidence from the literature
the use of dental implants in the esthetic zone is well documented in theliterature. Numerous controlled clinical trials show that the respective
overall implant survival and success rates are similar to those reported forother segments of the jaws. However, most of these studies do not includewell-defined esthetic parameters.
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consensus statement and recommended clinical procedures
regarding esthetics in implant dentistry
Statement A.2: Single-Tooth Replacement
For anterior single-tooth replacement in siteswithout tissue deficiencies, predictable
treatment outcomes, including esthetics, can be
achieved because tissue support is providedby adjacent teeth.
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consensus statement and recommended clinical procedures
regarding esthetics in implant dentistry
Statement A.3: Multiple-Tooth Replacement
The replacement of multiple adjacent missingteeth in theanterior maxilla with fixed implant
restoration is poorly documented. In this
context, esthetic restoration is not predictable,
particularly regarding the contours of the
interimplant soft tissue.
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consensus statement and recommended clinical procedures
regarding esthetics in implant dentistry
Statements A.4: Newer Surgical Approaches
Currently, the literature regarding estheticoutcomes 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.
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statement b:surgical considerations
Statement B.1: Planning and Execution
Implant therapy in the anterior maxilla isconsidered an advanced or complex procedure
and requires comprehensive preoperative
planning and precise surgical execution basedon a restoration-driven approach.
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statement b:surgical considerations
Statement B.2: Patient selection
Appropriate patient selection is essential in achievingesthetic treatment outcomes. Treatment of high-risk
patients identified through site analysis and general
risk assessment (medical status, periodontal
susceptibility, smoking, and other risks) should beundertaken with caution, since esthetic results are less
consistent.
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statement b:surgical considerations
Statement B.4: Implant Positioning
Correct three-dimensional implant placement
is essential for an esthetic treatment outcome.Respect of the comforts zones in these
dimensions results in an implant shoulder
located in an ideal position, allowing for anesthetic implant restoration with stable, long-
term peri-implant tissue support.
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statement b:surgical considerations
Statement B.4: Soft-Tissue Stability
For long-term esthetic soft-tissue stability, sufficient
horizontal and vertical bone volume is essential. Whendeficiencies exist, appropriate hard and/or soft-tissueaugmentation 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 isrecommended in the anterior maxilla. In certainsituations , a non-submerged approach can be considered.
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statements c:prosthodontic and restorative
procedures
Statement C.1: Standards for an Esthetic Fixed
Implant RestorationAn esthetic implant prosthesis was defined as one that is in harmony withthe peri-oral facial structures of the patient. The esthetic peri-implanttissues, including health, height, volume, color, and contours, must be in
harmony with the healthy surrounding dentition. The restoration shouldimitate the natural appearance of the missing dental unit(s) in color, form,texture, size and optical properties.
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statements c:prosthodontic and restorative
procedures
Statement C.4: Use of Provisional Restorations
To optimize esthetic treatment outcomes, theuse of provisional restorations with adequate
emergence profiles is recommended to guide
and shape the peri-implant tissue prior todefinitive restoration.
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diagn stic Fact rs f r esthetic risk
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diagnostic Factors for esthetic risk
assessment
1.Patients Treatment Expectations
2.Patients Smoking Habits
3.Height of the Lip Line on Smiling
4.Gingival Biotype in the Treatment Area
5.Shape of the Missing and Adjacent Teeth
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Pre-operative analysis and prosthetic treatment
planning in esthetic implant dentistry
6.Restorative Status of Teeth Adjacent to the
Edentulous Space
7.Character of the Edentulous Space
8.Width of the Hard and Soft Tissues in the
Edentulous Space
9.Height of the Hard and Soft Tissues in the
Edentulous Space
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Provisional restorations
can be either fixed or removable and must
1. Satisfy (within reason) the patients esthetic.
2. Be easy to fabricate and maintain.
3. Eliminate intermittent vertical pressure.
4. Be durable.
5. Provide diagnostic value.
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Provisional restorations
Options for ideal interim restorations:
1.FPD
2.Resin fiber-reinforced FPD
3.Orthodontics
4.Vacuform retainer
5.TP
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