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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
14 — issue 1/2015 Implant Dentistry Article LATERAL MAXILLARY INCISOR IMPLANT — key issues for aesthetic success — Dr. Philippe Russe, Former assistant at the Reims University and Hospital Private practice 9 rue Saint Symphorien 51100 Reims — Dr. Patrick Limbour, MCU-PH, Head of department of oral surgery, Pontchaillou University Hospital, Rennes Faced by a missing lateral incisor, practi- tioners often consider a wide range of issues and are also faced by numerous treatment options: – in a young patient, faced with a uni- lateral or bilateral agenesis, he has to choose between an orthodontic treatment that either opens up the spaces or closes them. This decision, when taken early in the overall treat- ment, will affect both the patient and theircaregiverfora longtime (Fig. 1); – in an adult patient, this is a conse- quence of bone, physiological, trau- matic or infectious resorption, which will result in a decision whetherornot torecommendabonereconstruction or a gingival augmentation. Ineverysituation,theresultswillbejudged bythepatientandthosearoundhim.Since the lateral maxillary incisor is an integral part of the smile, aesthetic expectations are generally very high and, if the results donotmeettheexpectations,disappoint- ment can be powerfully felt. When describing the different treat- ment stages, a number of pitfalls and dif- ficultieswillbehighlightedandadviceand clinical protocols will be given, in order to ensure that the results of this implant/ prosthetic treatment are predictable and as aestheticallyattractive as possible.This first article is concerned with these issues as regards the preprosthetic stages ; the second will consider the most important aspects of the prosthetic stages as well as aesthetic outcomes and their evolution over the long term. Anamnesis Once the usual contraindications for oral andimplantsurgeryhavebeeneliminated, particularattentionshouldbegiventothe patient’s answers concerning their smok- ing habits. Indeed, meta-analysis give an accurate picture of the consequences of smoking, with increases of: – peri-implantitis1 2 and bone loss2; – failure rates.3 The conclusions of Snider et al.4 can pro- vide recommendations for the practi- tioner faced with a patient who is a smoker: – the best is to ask the patient to stop smoking…; – if this approach is not acted on, then the patient must be warned of the in- creased risk of failure and of postop- erative complications. Thislastissueisimportant,assmokingcan be considered a lost opportunity as far as implant treatment is concerned. It is preferable to avoid patients that are smokers. Clinical examination The smile line When replacing atooth in an aesthetic re- gion, understanding the location of the smile line is one of the determining issues during the clinical examination. There are two factors to consider: the exposure of PART ONE — preprosthetic stages