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ePaper created 2016-03-11, 23:13:06 | version 1.38.0
18 — issue 2016 Advanced Implant Esthetics Article incisors appears to result in an improve- ment compared with wider implants. The margin of the papilla and the position of the collar, in relation to the contralateral incisor, are the two principal issues pre- sentedbyimplantreplacementofalateral incisor (Fig. 15). In most cases, the mesial papilla,betweenthecentralincisorandthe lateral incisor, is at an almost normal height,whereasthedistalpapilla,between the lateral incisor and the canine, is often shorteranddisplaysaslightverticaldeficit (Fig. 16). — Initial evolution Whentheimplantsarewellpositionedand the buccal soft and hard tissue are thick, theestheticoutcomeislasting.Intheearly years, an improvement of the outcome may occur owing to the soft tissue filling the prosthetic embrasure (Figs. 17a & b). — Continuous eruption Since the 1980s, authors such as Levers andDarling36 havedescribedthephenom- enon of continuous eruption, which re- sultsinaverticalizationofthemaxillaryin- cisors. The osseointegration of implants prevents them from following this migra- tionand,overtime,thelateralincisorscan endupinamoreapicalandbuccalposition than the central incisors. This phenome- non is sometimes perceptible after some yearshavepassed,whatevertheagewhen the implants were placed (Figs. 18a & b). Thus, the organization of anterior guid- ance becomes particularly important, since rapid movement of the central inci- sorscanoccurifthesearenotinocclusion when the implants are placed. During or- thodontic treatment, balanced anterior guidance for the central incisors and the canineswillbeoneofthemajorobjectives for the orthodontist. If there is bilateral agenesis, the symmetry of the smile will be maintained and the situation will be es- theticallymorefavorablethanforaunilat- eral replacement. After some years, the discrepancymaybecomequitesignificant and may be present just in the vertical plane or may be a combination, both ver- tical and horizontal (Figs. 19a–c). It was thoughtthatthisphenomenonwasthere- sult of placing implants too early, but in 2004 Bernard et al.37 showed that there was no difference between a group of youngadultsandagroupofadultsinterms of infraocclusion of implant-supported crowns in the esthetic region. In describ- ing the problems found in implant- supported anterior restorations (bluish gingiva, infraocclusion, exposure of abut- ment), Zachrisson38 poses the question: Is an implant the best solution for treating agenesis? Warn the patient of the negative impact of continuous eruption on the esthetic outcome. — Risk factors Andersson et al.,39 who followed 34 pa- tientsoveraperiodof17–19years,showed that severe infraocclusions (> 1 mm) af- fected 35% of the patients. They made several findings, including the following: Fig. 15 Fig. 16 Fig. 15 The collar level of tooth #22 is ideal, but the papillae are slightly truncated. Fig. 16 The distal papilla is slightly shorter than the mesial papilla (line shows difference in level). Fig. 17a Initial situation. Fig. 17b After three years, the papillae are slightly longer. Fig. 17a Fig. 17b Article_Russe_00-00.qxp_Layout 1 02.03.16 20:52 Seite 7 Article_Russe_00-00.qxp_Layout 102.03.1620:52 Seite 7