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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
16 — issue 1/2015 Implant Dentistry Article Documentation Taking photographs at the start of the treatmentwillmakeitpossibletomaintain a record of the initial condition, which is always useful if there are medical/legal problems at the end of the treatment. In addition,theimagesoftenmakeitpossible to see problems relating to width, axis or asymmetry that sometimes go unnoticed during a clinical examination. Check anterior guidance and absence of overjet. Complementary tests 2-D imaging PanoramicX-Raysorretroalveolarradiog- raphy make it possible to check the depth ofimplantableboneinrelationtothefloor of the nasal cavity, the bone level in rela- tion to that of adjacent teeth and the par- allelism of the central incisor and canine. 3-D imaging 3-D imaging is required to check the vestibular palatal dimensions of the bone crest. There are three possibilities: – the crest is sufficiently wide to take animplantwithoutanyboneaugmen- tation; – the crest is narrow, bone augmenta- tion is required prior to siting the im- plant (Fig. 6); – intermediatesituationswherethesit- ingoftheimplantwillbeaccompanied either by bone splitting or by guided bone regeneration. Orthodontic preparation When the adjacent teeth present apical convergence, the orthodontic prepara- tion should create a mesio-distal dimen- sion atthe level ofthe rootthat allowsthe implant to pass with a margin of at least 1mm of bone (Figs. 7 and 8). Where there is a controlateral incisor of a normal size, therulefortheorthodontististomeasure the width of that tooth carefully and to recreate the same width in the crown of the planned implant. Where the contro- lateral incisoris riziform,the orthodontist should plan the future face of the tooth in ordertoachievetwolateralswiththesame shape. Diastemas around the riziform tooth make it possible to achieve a smile that, in the end, is almost symmetrical (Fig. 9). The riziform incisordoes not haveto be in the centre of the space but should be positioned in such a way that the papillae and the future zenith of the tooth are op- timised. The zenith should be located 0.4mmdistalfromthecentreofthetooth foralateralincisor,accordingtoChuet al.9 (Figs. 10a and b). Sometimes, a zenith sit- uatedmorethan1mmfromalinebetween the collars of the central incisor and the canine should be surgically altered by coronal lengthening as a lateral incisor that is too short can also be aesthetically unacceptable. The orthodontist should anticipate the future prosthetic morphology of the riziform incisor. Fig.7Fig.6 Fig.9 Fig.10a Fig.10b Fig.8 Fig. 6 Simulation of location of 3 mm implant in cross section (case shown in Fig. 1). Fig. 7 Evidence of radicular convergence. Fig. 8 Orthodontic layout of implant corridor. Fig. 9 Diastemas created around a riziform tooth to obtain a space of 6 mm. Figs. 10a & b Centered location of zenith of 22 (a) (arrow) to be taken into account when making the crown 12 (b). Fig. 11 Cortical graft in place, shaped to support future papillae (case as shown in Fig. 1). Fig.11