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implants - international magazine of oral implantology

I research Fig. 6_Occlusal view of the implants. Fig. 7_Post-op radiograph. Fig. 8_The acrylic resin temporary bridge is placed. Fig. 9_Clinical view of the all-ceramic ZrO2 bridge five years after surgery. the implants were loaded. Six months after surgery, the YSZ implants were definitively restored with a ZrO2 bridge. A light-pink ceramic layer was applied to themarginalareasofregions2.1to2.3tobettersup- porttheupperlipandlimitthewidthoftheinterden- tal space (Fig. 9). Follow-up appointments were scheduled for six months after prosthesis delivery and thereafter once a year. Periodontal indices were measured and stan- dardised periapical radiographs were obtained. The plaque index and bleeding on probing scores were 1, exceptatthelastfollow-up.Noimplantshadprobing depthvaluesoflessthan5mm.Mobilitywasnotpres- ent at any site. No pain (spontaneous or on percus- sion) or paraesthesia was reported. From baseline to fiveyearsaftersurgery,radiographicalevaluationob- served the absence of peri-implant radiolucency and noimplantexhibitedmarginalboneresorptionatany follow-up (Figs. 10 & 11). _Discussion Titaniumdentalimplantshaveprovedtobehighly successful in replacing missing teeth. Several studies have demonstrated the successful osseointegration of this material and its use for restoration in patients with partial or total edentulism.17 In recent years, nu- merous studies have focused on the development of implantsurfacestoensurebetterandfasterosseoin- tegration and to re-establish masticatory function in a shorter period.18, 19 Although excellent results have beenobtainedinthemaxillaryanteriorregionbysev- eral clinicians, aesthetics remains a challenge for im- plant dentistry. Titanium implants are of a grey colour, which can shinethroughgingivaltissue,particularlyinthinbio- typesorinpatientswithahighsmileline.Moreover,it mustbeconsideredthatsofttissuearounddentalim- plants may shrink or develop gingival recession, or that peri-implantitis may occur, thus compromising the overall treatment outcome, particularly if treat- ment entails an aesthetic region. In recent years, several solutions to this problem havebeenproposed.Variousauthorshavesuggested placing implants 3 to 4 mm apical to the cemento- enamel junction or free gingival margin of adjacent teeth, considering that soft-tissue margins around implantstendtore-establishabiologicalwidth.20 Im- plantspositionedtoofarapicallyinanattempttoes- tablish appropriate biological width can cause gingi- valrecession.21 Gingivalrecessionmayalsodevelopin thingingivalbiotypesbecausethesetissuesaremore sensitive to trauma and inflammation. For these rea- sons, surgical approaches such as connective tissue grafts have been suggested to augment tissue thick- ness and improve peri-implant aesthetics.22, 23 How- ever,thesetechniquesarenotalwayscompletelypre- dictable from an aesthetic point of view. Moreover, morbidity of the donor site and patient discomfort mustalsobetakenintoaccount.Otherauthors24 have recommended colouring the implant neck, thus changingtheopticalappearanceofperi-implantmu- cosa. For the same reason, a great number of investi- gations have been conducted on tooth-coloured im- plants. Various ceramics have been tested as coating material, such as ZrO2 and Al2O3.13, 26 However, even if thestudiesconductedinthe1990sshowedbetterre- sults than earlier investigations, these implants did not have adequate mechanical properties for long- term loading27 or required large diameters that were incompatiblewithuseintheanteriorregionwithlim- 08 I implants3_2012 Fig. 6 Fig. 7 Fig. 8 Fig. 9