Implant in the Esthetic Zone Flashcards
Contrary to missing a posterior tooth, most patients have an __ regarding a maxillary anterior missing tooth
emotional response
__ implant is one of the simplest procedures in implant surgery and prosthetics
Posterior single-tooth
__ is often the most difficult procedure in all of implant dentistry
Maxillary anterior single-tooth replacement
Why esthetics matter
Impact on patient satisfaction and quality of life
Role in social and professional interactions
Higher expectations for natural-looking restorations
Critical anatomy of implants in the esthetic zone
Alveolar bone dimensions/quality (PIC)
Nasopalatine canal
Gingival biotype
Attempting to place implants in cases with large nasopalatine canal leads to
penetration into the canal and a soft tissue interface
What are the 2 types of gingival biotypes
Thick and thin
(Pics of both)
This type of gingival biotype has more resistance to shrinkage/recession of periodontal pocket after bone loss
Thick biotype
This type of gingival biotype is more prone to shrinkage after extraction and more difficult to augment after extraction.
Thin biotype
Treatment planning and diagnosis : Comprehensive assessment includes
Clinical examination
Radiographic analysis
Digital planning
What do we evaluate at the clinical examination
Smile line and lip dynamics
Important to evaluate when observing the cervical region
Clinical results such as these things are much LESS demanding
Emergence contours
Interdental papilla presence
Shade and contour of the crown
Radiographic analysis includes
CBCT scans for bone assessment
Digital planning includes
CAD/CAM integration
What are the smile design principles
Proportion and symmetry
Tooth form, size, shade
Patients facial features
When looking at tooth form, size, and shade matching, we are looking at the influence on __ and __
interproximal contact area and gingival embrasure
With a square shaped tooth, it is most favorable when the contact is further __
apical
With a triangular shaped tooth, it is less __ and the contact is more __
predictable
Incisal
The distance between the underlying interproximal alveolar crest height on the adjacent natural teeth and the final prosthetic contact point dictates the presence or absence of __
Interdental papilla
Interdental papilla:
If this distance is more than __, the complete papilla formation will be compromised, this is called a __
5 mm
Black triangle
Know the tooth size dimensions
Look at the pic
What are some anatomic challenges
Natural tooth size vs. Implant diameter
Compromised bone height
Compromised mesiodistal space
Compromised faciopalatal width
Natural tooth size vs. implant diameter:
Challenges in restoring __ with round-diameter implants
cervical esthetics
Compromised bone height:
Importance of evaluating bone available for implant size and position.
Influences the __
soft tissue drape, implant size, implant position, and the final esthetic outcome
(Look at pics)
Compromised bone height:
Bone height and the impact on soft tissue height.
Midcrestal =
Interproximal =
Midcrestal = 2-3 mm below CEJ
Interproximal = scalloped 3 mm more incisal than midcrestal
Compromised mesiodistal space:
__ for esthetic outcomes
Minimum space requirements
(Look at pics for compromised mesiodistal space)
Compromised faciopalatal width:
Bone width primarily from the __
facial region
Compromised faciopalatal width:
Necessity of bone grafts to __
restore ridge anatomy
Compromised faciopalatal width:
Available bone should be at least __
3mm greater than the implant diameter
Ideal implant positioning:
__ below the free gingival margin
__ from adjacent teeth
__ of buccal bone
3 mm
1.5 mm
2 mm
Ideal implant position:
Faciopalatal - if it is too buccal =
dehiscence and gingival recession
(Look at pic)
Ideal implant position:
Faciopalatal - if it is too palatal =
Improper restoration, not hygienic, not esthetic
Ideal implant position:
Facial angulation - risks of facial angulation leading to __ and __
esthetic and functional complications
(look at pics)
Ideal implant position:
Cingulum angulation - Challenges with __ and __
screw-retained crowns and facial ridge lap
(plaque control in almost impossible)
Ideal implant position:
Ideal angulation - The implant must be positioned in such a way that the __ aspect of the implant __ just touches an imaginary line that touches the __ of the adjacent teeth
Buccal
platform
incisal edges
Common esthetic complications
Soft tissue recession / loss of papilla
Malposition affecting smile line
Peri-implantitis
