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12 — issue 2016 Advanced Implant Esthetics Article LATERAL MAXILLARY INCISOR IMPLANT: — Key issues for esthetic success — Dr. Philippe Russe formerly worked as an assis- tant at the Reims University Hospital and now works at a private practice in Reims, France. He can be contacted at russe-phil@orange.fr. Dr. Philippe Russe & Prof. Patrice Margossian, France Having discussed in the previous article (see editorial note), all of the prepros- thetic stages forthe replacement of a lat- eral maxillaryincisorand having explained the surgical procedures required to im- prove the final esthetic outcome, in this second part, we discuss the prosthetic stages. Observation of clinical cases over a period of almost 15 years has made it possibletoassess,overthedifferentsteps in the prosthetic chain, the impact of par- ticular choices of components or clinical procedures on the final esthetic outcome of the gingival setting and the ceramic crown. As a result, for each clinical step, there are recommendations to help opti- mize and complete the surgical outcome and to ensure a long-lasting result. Inthelastsection,theestheticoutcome will be considered in relation to its medium- and long-term evolution, com- pared with the initial results. The effects ofcontinuoustootheruptionandananaly- sisofdifferentriskfactorsleadtheauthors tomakeclinicalrecommendationstomin- imize any negative effects. Provisional prosthesis A provisional prosthesis can be fabricated atdifferentstagesoftreatment:whenthe implant is placed to provide an immediate temporary solution, when the implant is uncovered, or once the soft tissues have healed. Atemporaryabutment can be uti- lized, but this will involve greater manip- ulation of the subgingival components (Figs. 1a & b). — One abutment, one time The concept ofthe single abutment being seated early and definitively during im- plant treatment in order to preserve the attachment of soft tissues around the abutment is based on a publication many yearsagobyAbrahamssonetal.1 Forthese authors,themultipleconnectionsanddis- connections of healing screws resulted in apicalization of the periimplant bone.This study is now considered to be biased be- cause of the cleaning of healing screws with alcohol (which destroysthe attached fibroblasts); nevertheless, it provided the basis for the one-abutment–one-time concept (OAOT) put forward by Maurice and Henry Salama at conferences from 2007. At present,the medical literature is generally in favor of this concept, even though research results are mixed: – In dogs, the results of Iglhaut et al.2 showed a highly negative outcome of connection and disconnection at four and six weeks, while in Alves et al.3 five such manipulations between 6 and 14 weeks had no negative consequences. — Prof. Patrice Margossian is former director of the implantology department at the Marseille University Hospital and works at a private practice in Marseille, France. He can be contacted at pm@patricemargossian.com. PART II — Prosthetic stages and long-term issues Article_Russe_00-00.qxp_Layout 1 02.03.16 20:52 Seite 1 Article_Russe_00-00.qxp_Layout 102.03.1620:52 Seite 1