Implant Therapy: A Guide to Improved Esthetics

mm Written by Andrew Sedler

Before
After

Implant therapy has been a true game-changer for people suffering from tooth loss. As the population ages and edentulism becomes more prevalent, implants as a restorative option continue to grow.

For patients, the idea of placing an implant as opposed to other treatment options such as a three-unit bridge or removable partial denture is a more appealing option. This is especially true when edentulism occurs in the esthetic zone. This area is by far the most challenging and requires proper planning to ensure the case meets the expectations of the patient.

Presenting the Case

Burbank Dental Lab is fortunate to have worked with Dr. Daniel Domingue on the following anterior implant case. As with most anterior maxillary cases, this case is presented with challenges.

The lateral was in need of extraction.

anterior implant - Dr. Daniel Domingue

The implant placed was pilot drill guided, and the implant type was an AnyRidge implant by Megagen.

It was determined that immediate loading of the implant was a viable option. Whenever the case calls for replacing one to two teeth in the anterior maxilla, the provisional process can be simplified through immediate loading.

Once healed, the temp can be removed and the soft tissue scanned.

The case was scanned using the appropriate scan body for the implant system used in this case. This scan records the proper height, angle, and implant position.

In addition, a scan of the tissue and opposing was done.

The digital scans were sent to Burbank Dental Lab, where the challenge of designing and fabricating a restoration that maximizes esthetics by blending in with the surrounding dentition began. It is this aspect that is critical in supporting clinicians to ensure overall patient satisfaction.

To ensure these types of cases meet these expectations consider the following:

Small-line Consideration

The height and width of a patient’s smile-line are important to consider when determining whether a case will meet patient expectations.

A high smile-line will reveal much more of the gingival tissue and restoration. The key is to maintain the peri-implant tissue support throughout the planning, surgery, provisionalization, and restorative steps.

Lower smile lines require less of this type of evaluation.

Implant Placement

Implant placement requires evaluating the restorative goals and present biological issues. The biological issues focus on the management of bone and tissue, while the restorative concerns focus on aesthetics and proper contour.

Abutment Selection

This is critical in achieving the desired results.  

  1. Stock Abutments:
    While most implant companies offer stock abutment options that come in a selection of contours and angles, these are usually extremely limited. This is especially true when trying to achieve tissue support and an ideal emergence profile. Also, the crown margin relies on the height of the abutment and the depth of the implant. 
     
  2. Custom Abutments:
    In most cases, custom abutments provide exceptional aesthetic results. Custom abutments provide ideal implant angulation, position, and depth. The soft tissue is ideally supported.

Case Planning

It was decided to restore with a Burbank Dental Lab, SMART1 custom zirconia abutment with a titanium base.

SMART 1 Implants: Cement-Retained Implant Success

SMART 1 Zirconia abutments offer a superior esthetic result by eliminating the gray cast shown through the tissue that can be present in some circumstances with titanium abutments.

When designing the abutment, the implant team at Burbank Dental Lab evaluated the patient’s soft tissue, contours, and emergence profile to create the ideal abutment design custom to the patient’s specific needs. Using some of the most advanced computer-aided manufacturing equipment in the industry, the abutment was milled.

The patient’s esthetic needs were evaluated to decide on the restorative material to fabricate the final crown. This step is critical to the overall success of the case as the final crown needs to blend seamlessly with the adjacent teeth.

All On X Success Guide

Proper communication from Dr. Domingue is what led to such an amazing outcome. The best way to communicate the specific esthetic needs of the case are as follows:

Block out any unfavorable outside light sources.

Eliminate any color influencers such as colored walls, floors, clothing, or makeup. A neutral-colored cloth can be used to hide any color influencers.

  1. Use balanced lighting that is as close to natural light as possible.
  2. Block out any unfavorable outside light sources.
  3. Eliminate any color influencers such as colored walls, floors, clothing, or makeup. A neutral-colored cloth can be used to hide any color influencers.
  4. When choosing a shade, try not to look at the tooth for longer than 5 seconds.
  5. Make sure the teeth are hydrated.
  6. The patient should be sitting upright to allow for adequate light entry.
  7. Use lip retractors to eliminate any shadows.
  8. Place the shade tab in the same position as the tooth that is to be matched
  9. The facial aspect of the shade tab should be parallel to the facial aspect of the tooth.
  10. Next, place the incisal edge of the tab to the incisal edge of the tooth. (Figure 3, shown below)
  11. Take photos of the proposed shade tabs in the proper positions stated above.
Place the incisal edge of the tab to the incisal edge of the tooth
Figure 3

The Final Restoration

Based on all of the information provided and the specific esthetic needs of this case, an E.max crown was prescribed as the final restoration. E.max is an excellent material when esthetics is the number one concern.

E.max has a wide color selection and translucency options, and a wide range of benefits, including:

The E.max crown was fabricated over the implant abutment. It was cemented to the Smart1 Zirconia abutment using TherCem by Bisco Dental.

The Shade Taking Process

Considering all the aspects of what makes an implant case successful, including proper planning, skill from both the clinician and the dental lab, and proper detailed communication is what makes all the difference in creating a predictable, functional, and esthetic restoration.

Request a free laminated Success Guide by Burbank Dental Lab

Special Thanks

Burbank Dental Lab would like to thank Dr. Daniel Domingue for letting us provide lab support for this case.

Dr. Danny Domingue
Dr. Daniel Domingue

Did you like this article?

Let us know by giving us a clap!

1+

Top 10 Most Clapped Articles

Resource Center

Products

Slide 1

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.