Dental Tribune South African Edition

6 Dental Tribune South African Edition - March 2014 The challenge in the aesthetic area from the surgical aspect Dr Schneider Gadi - DMD, Specialist in Periodontics Alpha-Bio Tec Research and Academic Consultant The ideal placement of a single implant or of several implants in the aesthetic area O-G 2 mm under the CEJ of the adjacent teeth. M-O A minimum space of 1.5 mm should be left from the adjacent teeth. B-P A minimum of 1 mm of bone should be left at the circumference of the implant. Angulation The implant faces an imaginary line connecting the cingulum of the adjacent teeth. If the implant is placed buccally to this line, angulated abutments should be used in order to correct the angle. Space between implants A minimum space of 3 mm should be left between the margins of adjacent implants in order to obtain a papilla. Space between the contact point and the proximal bone (Tarnow law) A maximum space of 5 mm should be left between the peak of the proximal bone and the contact point of the crown with the adjacent teeth. The distance between the two red points (in the photo) - the greater the distance, the smaller the chances of obtaining a papilla (Tarnow OS). The main aesthetic problem arises from the amount of bone in the buccal region: 1. Crater formation around the tooth According to the literature, the circumference of the alveolus is a minimum of 1 .5 mm, which means that 2-4 mm of bone on the buccal surface of the implant are necessary in order to prevent a buccal-marginal loss of bone (Spray 00). 2. Rapid loss of bone in the premaxillary region • Proclination of the front teeth • Prominent roots • A very thin buccal plate These anatomic conditions cause rapid and extensive bone loss mainly in the anterior buccal region. About one third of the buccal plate is resorbed in the first month following the extraction. Bone resorption begins in the first week following the extraction and causes extensive thinning of the buccal plate during the first three weeks (Carlsson 67). Immediate Significant buccal implantation in the resorption after 3 PM region with a months thin buccal plate 3. Implant insertion does not prevent buccal bone resorption Immediate implantation The buccal bone is in the molar region with maintained after 3 a thick buccal plate months Buccal bone resorption is affected by ridge anatomy (bone thickness) and not by the placement of an implant (Araujo 06). Conclusions: •Critical bone mass (blood supply) is necessary in order to preserve the buccal plate and achieve an esthetic result. •It is not sufficient to leave about 1 mm of bone on the buccal side of the implant, but rather a minimum of 2 mm of bone should be left. •Even if the whole implant is within the bone coverage and the buccal plate is thin, bone augmentation should be performed in order to thicken and maintain the buccal plate. •The bone preservation is dependent mainly upon the surgeon. Data on file.