The anterior area presents significant challenges when it comes to dental implant placement, both surgically and in terms of achieving satisfactory esthetics. This surgical procedure is complex and necessitates meticulous planning and precise implant positioning, all with the goal of achieving optimal restorative outcomes.
The crucial aspect lies in creating a restoration that seamlessly integrates with the adjacent teeth and enhances the aesthetic appeal. Patients greatly prefer the option of implant placement over alternatives like a three-unit fixed bridge, resin-bonded bridge, or removable partial denture. Thus, ensuring successful outcomes with anterior implants is vital for overall patient contentment.
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:
Considering the soft and hard tissue before deciding to place an implant is imperative for an appropriate implant restoration.
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.
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.
To ensure precise implant placement, it is crucial to begin with a diagnostic wax-up. This step is particularly important for achieving the correct apico-coronal positioning of the implant. The diagnostic wax-up aids in visualizing the relationship between the restoration, implant, and soft tissue.
Additionally, it not only gives the patient an idea of the expected outcome but also assists in determining the feasibility of the treatment.
A surgical guide can be fabricated based on the diagnostic wax-up. It replicates the emergence profile and restoration shape, allowing for precise verification of implant placement and positioning. This step is crucial for effectively implementing the plan and managing esthetic expectations.
Surgical guides come in various types, including model-based guides that can be created using gutta-percha, radio-opaque acrylic, or metal cylinders. These guides are made from the diagnostic wax-up, as their name implies.
Furthermore, precise surgical tools derived from cone-beam computed tomography (CBCT) scans offer accuracy and can be produced using various dental implant processes. These processes involve the production of guides by Burbank Dental Lab or other external suppliers. These guides ensure reliable outcomes and offer the following advantages:
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.
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 for 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 who 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.