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ePaper created 2016-03-11, 23:13:06 | version 1.38.0
22 — issue 2016 Advanced Implant Esthetics Article FIVE KEYS — to more predictable esthetic restoration of anterior implants — Dr. Xavier Vela Nebot, M.D., D.D.S., is a visiting professor at the implantology department of the European University of Madrid and a member of the Barcelona Osseointegration Research Group in Spain. — Dr. José Miguel Castro Hoyle, M.Sc., D.D.S., is a Master of Oral Implantol- ogy student at the Depart- ment of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain. — Dr. Maribel Segalà Torres, M.D., D.D.S., is a member of the Barcelona Osseointegration Research Group. — Dr. Jaime Jiménez García, D.D.S., Ph.D., is chairman of the implantol- ogy department of the Euro- pean University of Madrid and a visiting professor at the New York University College of Dentistry in the U.S. — Javier Pérez López is a laboratory technician at Oral Design in Lugo, Spain. He has also lectured widely on esthetic prosthesis. — Dr. Xavier Rodríguez Ciurana, M.D., Ph.D., is a visiting professor at the implantology department of the European University of Madrid and a member of the Barcelona Osseointegration Research Group. Dr. Xavier Vela Nebot, Dr. José Miguel Castro Hoyle, Dr. Maribel Segalà Torres, Dr. Jaime Jiménez García, Javier Pérez López & Dr. Xavier Rodríguez Ciurana, Spain Introduction Dental implants have enabled cliniciansto replace missing teeth and return function and harmony to patients owing to their high predictability.1 However, it can be challenging to create implant-supported restorationsthatemulatethenaturalden- tition. Among the guidelines that have been proposed for achieving esthetic ex- cellence,manyfocusonmaintainingoren- hancing the volume of periimplant soft and hard tissue.2 This paper describes five keys to achieving and maintaining dento- gingival harmony and obtaining highly estheticanteriorimplantrestorations.Use of an implantthatfacilitates adherenceto several of these principles is illustrated with a case description. The five keys — 1. Tissue optimization (Fig. 1a) Several studies have documented post- extraction resorption patterns that de- monstratehorizontalandverticalboneloss during the first year after extraction.3, 4 Someboneresorptionhasbeendescribed at sites where the extracted teeth were immediately replaced with implants.5 The objectives of tissue optimization are to diagnose the volume of soft and hard tissue and, in the absence of an ade- quate amount, prepare for augmentation of the volume. Augmentation procedures may be beneficial in preventing black tri- angles and creating natural emergence profiles.6–8 An early implant placement protocol9 should be applied when tooth extraction is required at a site with a thin gingivalphenotype.Althoughthisapproach does not allow adequate time for bone to formintheextractedsite,itprovidesasoft- tissue seal by primary intention. — 2. Gingival remodeling (Fig. 1b) Once the volume of the gingival tissue above or adjacent to the implant has been optimized, some reshaping of the tissue should be considered. Use of an ovate pontic has been suggested to support the gingival tissue coronal to the implant shoulder, creating pseudopapillae and a naturalemergenceprofile.Theovatepon- tic may also expose the submerged im- plant and avoid the need for a second sur- gery to obtain access to the cover screw. Avoidingasecondsurgerywillhelptopre- serve the gingival architecture and mini- mize soft-tissue scar retraction.10 The use of provisional restorations to sculpt the soft tissue without causing re- cessionorretractionisfundamental.Most fixed and removable prostheses can ac- complish this goal.10 Anothertechnique is tousecementedfixedprovisionalrestora- tionsandminimallyinvasivepalatalprepa- rations.11 Pressure should gradually be im- posed on the soft tissue from the palatal to the labial aspect and the mesial to the distalaspectinordertodisplacetissuevol- ume toward the areas adjacent to the prostheticcrown,wherepapillaeandcon- vex contours are desired for a natural emergence profile. — 3. Handling reduction (Fig. 1c) Once an ideal tissue form has been ob- tained,itmustbepreservedandstabilized. Frequentdisconnectionandreconnection Article_Vela_00-00.qxp_Layout 1 02.03.16 20:53 Seite 1 Article_Vela_00-00.qxp_Layout 102.03.1620:53 Seite 1