Implant Single Tooth 1/2

8/7/2019 Implant Single Tooth 1/2

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single tooth

replacementSCE

Friday, February 18, 2011


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outline

Posterior tooth replacement

Tooth replacement in Esthetic zone



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Treatment option

fixed partial denture

removable partial denture

implant fixed restoration



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review patient medical history for

diseases

medication e.g. osteoporosis drug,

anticoagulant, etc.allergy e.g. penicillin



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previous dental history as an information



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take radiographs and impressions

mounted casts in articulator



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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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minimum vertical clearance for abutment

height + thickness of the restorations



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wax up tooth can be made for surgical guide

preparation



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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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implant surgery visit: inform patient aboutpost-op pain and instruction, prescribe pain

medication and/or antibiotics and mouthrinse



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follow-up visit and suture removal



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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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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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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.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.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.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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Implant Single Tooth 1/2

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