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ePaper created 2015-05-29, 13:18:43 | version 1.38.0
technique _ first part of an implant treatment I Anamnesis Once the usual contraindications for oral and implant surgery have been eliminated, particular at- tentionshouldbegiventothepatient’sanswerscon- cerning their smoking 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 TheconclusionsofSnideretal.4 canproviderecom- mendations for the practitioner faced with a patient whoisasmoker: _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 increased risk of failure and of postoperative complications. Thislastissueisimportant,assmokingcanbecon- sideredalostopportunityasfarasimplanttreatment is concerned. “It is preferable to avoid patients that are smokers.” _Clinical examination Thesmileline When replacing a tooth in an aesthetic region, understandingthelocationofthesmilelineisone of the determining issues during the clinical ex- amination. There are two factors to consider: the exposure of papillae and visibility of the collar of the lateral incisor, and there is one significant problem: any aesthetic deficit experienced by the patient tends to make them change their smile line,whichcanhappenmoreorlessasaconscious process and this can be a source of significant errors. Analysis of gingival composition is also a determining issue in positioning the collar of the lateral incisors in a location that is aesthetically optimal. The gull-wing profile, where the collar of the lateral incisors is slightly more coronal than that of the front teeth or the canine teeth, is con- sidered to be more attractive according to Chiche5 (Fig. 2). Dentalaesthetics As regards dental aesthetics, the proportions of theproposedimplantsupportedtoothcanreflecttwo different scenarios: Fig. 4_According to Levin, following the golden ratio, the width of the lateral incisor y = 0.62 x and, for Preston, it is 0.66 x (images from Papathanassiou).6 Fig. 5_Evidence of bone deficit at 22 (case shown in Fig.1).6 I 13cone beam2_2015 Fig. 6_Simulation of location of 3mm6 implant in cross section (case shown in Fig.1).6 Fig. 7_Evidence of radicular convergence. Fig. 8_Orthodontic layout of implant corridor. Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8