Please activate JavaScript!
Please install Adobe Flash Player, click here for download

cone beam – international magazine of cone beam dentistry

I technique _ first part of an implant treatment _there is a unilateral missing tooth and the contro- lateralincisorhasnormalandaestheticallypleasing proportions. The objective will be to create a lateral incisor implant that is a mirror image; _withthesamesituationbutwherethecontrolateral incisor is small; this is a situation that occurs fre- quentlyinunilateralagenesiswheretheincisorthat is present is riziform or, if there is agenesis of both lateral incisors, the clinical examination should gather the information required to decide on the dimensionsandcoronalaxesoftheproposedlateral incisors.Ananalysisoftheocclusionandthedimen- sions of the central incisors are the clinical parame- tersthatmakeitpossibletoestablishthecharacter- istics of the planned prosthetic teeth. Theanatomyofthelateralincisorhasbeenthesub- ject of various publications, including, notably, by Pa- pathanassiou6 who defined average dimensions and a typical form (Fig. 3a) and also presented numerous morphological variants affecting these dimensions and also other characteristics such as the crown/root ratioandthecoronalandrootaxes(Fig.3b).Thesemor- phologicalcriteria,whichcannowbefoundusing3-D imaging, have had a significant influence on the loca- tionofimplantsinallspatialplanesinordertoachieve the goal of harmony of form and dimension. Other publications, such as those by Levin7 and Preston8 makeitpossibletoestimatethewidthofabsentlateral incisorsonthebasisofthecentralincisors(Fig.4). “Establish the ideal width and orientation of the planned prosthetic crown.” Implantlocation A clinically significant deficit signals the need for reconstruction of hard tissue but, conversely, asitewithoutatoothwithnolossofvolumeshould be subjected to a three-dimensional X-ray, as thick soft tissue can hide a lack of hard tissue (Fig. 5). A thin tissue biotype or a lack of attached gingiva can be a sign that gingival augmentation surgery willberequired,particularlyifabonegraftneedsto be performed. Occlusion For orthodontic treatments, the anterior guid- anceshouldbeanalyzedcarefully.Itcanbetempt- ing to increase the perimeter of the maxillary arcadeinordertoobtain,attheleast,implantcor- ridors that are sufficiently wide at the level of 12 or 22. However, an overjet will make it very likely that the natural teeth will move in relation to the implant prosthesis with highly negative conse- quencesforthesustainabilityofthecosmeticout- come. Documentation Taking photographs at the start of the treat- ment will make it possible to maintain a record of theinitialcondition,whichisalwaysusefulifthere aremedical/legalproblemsattheendofthetreat- ment. In addition, the images often make it possi- bletoseeproblemsrelatingtowidth,axisorasym- metry that sometimes go unnoticed during a clin- ical examination. “Check anterior guidance and absence of overjet.” Fig. 9_Diastemas created around a riziform tooth to obtain a space of 6mm. Figs. 10a & b_Centered location of zenith of 22 (a) (arrow) to be taken into account when making the crown 12 (b). 14 I cone beam2_2015 Fig. 9 Fig. 10a Fig. 10b

Pages Overview