all-ceramic restorations

Written by Andrew Sedler

Written by Andrew Sedler

Anterior Implant Rehabilitation:

Setting the Foundation

Slider

Placing implants in the anterior area is extremely challenging both in terms of the surgical procedure and the esthetic outcome. This surgery is a complicated procedure that requires comprehensive planning and precision in implant placement, all driven by the restorative result. The key is to create a restoration that blends in with the surrounding dentition and maximizes esthetics. For patients, the option to place an implant is significantly more appealing than other alternatives such as a three-unit fixed bridge, resin-bonded bridge, or a removable partial denture. Maximizing success with anterior implants is critical to overall patient satisfaction.

Burbank Dental Lab

"Maximizing success with anterior implants is critical to overall patient satisfaction."

--- Andrew Sedler, COO

Clinical Evaluation

Creating successful anterior implant cases begins with careful case selection through proper clinical evaluation. While it is an excellent option for many, some limiters can significantly impact the ability to achieve a successful case that will meet the needs and expectations of the patient. By managing the process from case selection to restorative prosthesis, these cases can be life-changing as well as critical to the success of the dental practice.

The first step is to evaluate both hard and soft tissue. It is critical to the success of the case to evaluate the periodontal condition of the teeth. For example, if there is interproximal horizontal bone loss from periodontitis, this will significantly affect the shape and position of the interproximal papilla. One cannot overstate the influence that bone and soft tissue defects will have on impacting the ability to create an esthetic outcome. Therefore it is crucial to perform these evaluations:

  • A thorough radiographic evaluation (CT scan or cone beam)
  • Clinical evaluation of adjacent teeth, recessions, mesiodistal width, and gingival biotype

Considering the soft and hard tissue before deciding to place an implant is imperative for an appropriate implant restoration.

Smile Line Evaluation

Next, the patient's smile will play a big part in whether optimal esthetics is achievable. Evaluating both the shape and height of the adjacent teeth, as well as the height and width of the smile line, is vital in determining whether the case will meet the esthetic expectations desired. Exposure of gingival tissue in a high smile line is more significant than with average or low smile lines. When the smile line is high, both the gingival tissues and restoration will be visible.

As a result, the focus will be to maintain the peri-implant soft tissue support. Focusing on maintaining this soft tissue support will be necessary throughout the planning, surgical, temporization, and restorative processes. Of course, due to the entire restoration's ability to hide behind the upper lip, the lower smile lines require less of this type of consideration.

Burbank Dental Lab
Burbank Dental Lab Laminated Success Guide

REQUEST YOUR FREE IMPLANT SUCCESS GUIDE BELOW

Free Success Guide Campaign

Implant Placement

It is important to determine the restorative and biological concerns when preparing the aesthetic considerations for placing the implant. On the restorative end, it needs to be set to the confines of proper contour so that it is visually appealing. Biologically the considerations are more focused on tissue and bone management. The most critical area for precision in the placement of an implant is in the anterior maxilla. If the implant is off by even 1mm or less, the case results can be compromised.

The Wax-Up

Diagnostic Wax-Up

It is necessary to start with a diagnostic wax-up to ensure accuracy in the placement of the implant. This step is especially true when trying to ensure the appropriate apico-coronal positioning of the implant. A diagnostic wax-up will help to present the soft tissue with how it relates to the restoration and implant. Not only does a diagnostic wax-up provide the patient with a visual of what to expect, but it also helps to determine what is possible.

Surgical Guide

Dental Implant Workflows

From the diagnostic wax-up, a surgical guide can be fabricated. The emergence profile and restoration shape are duplicated on the guide and used to verify both the placement and positioning of the implant. This step is a critical component of ensuring that the plan is carried out effectively to manage esthetic expectations properly.

There are different types of surgical guides available. Model-based guides can be fabricated with gutta-percha, radio-opaque acrylic, or metal cylinders. As the name suggests, these guides are made from the diagnostic wax-up.

In addition, guided surgery appliances that are created from cone-beam computed tomography (CBCT) scans are exact and can be manufactured from different dental implant workflows. These workflows include guides that are designed and manufactured by either Burbank Dental Lab or third party providers. These guides provide predictable results along with the following benefits:

  • Custom healing caps to help shape the tissue and aid in creating an ideal emergence profile as well as papillae support
  • Prefabricated provisionals to be used the day of the surgery
  • Pre-designed impression for solid model verification
  • Precision guide rings
  • FDA Approved resin for printing

The importance of the proper placement of implants to the overall success of the case cannot be stressed enough. Guides help to ensure this critical component meets expectations.

Abutment Selection

Titanium Abutments

The restorative process will be the final step in an anterior implant case. A custom abutment, such as those designed with CAD/CAM systems, will provide the best esthetics and function. A custom abutment can be designed to an ideal situation to support the restorative plan, including correct and proper angulation. The fabrication of the final restoration is then completed. In the esthetic zone, it is often required to layer color in the restoration to match the surrounding dentition properly. This step will ensure excellent, natural results that meet the expectations of the patient.

An anterior implant restoration offers an excellent solution for patients that have missing dentition and require a conservative esthetic solution. This surgical procedure will effectively meet the esthetic outcome for the patient's teeth when proper case planning is understood and implemented.

With the restorative process being the final step of a surgical implant procedure, it is vital to follow and take into account the preliminary work that must be done beforehand. At Burbank Dental Lab, we understand the importance of managing a patient's esthetic demands, especially in the esthetic zone, and are available to answer any questions.

Burbank Dental Lab

Resource Center

Products

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

Fabrication
of the future
is here!

Burbank Dental Lab has three new state-of-the-art Carbon M2 printers. We are very excited about the options that these cutting-edge printers will allow us to offer our dental clients. Here are some of the advantages that these printers will begin to deliver to you and your dental practice.

Our New
State-Of-The-Art
3d Printers

Carbon offers a highly dependable 3D manufacturing solution for many dental applications with its breakthrough Digital Light Synthesis™ technology, enabled by a wide range of dental materials.

Slider