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ePaper created 2016-03-24, 17:16:09 | version 1.38.0
research | 171 2016 implants When describing the different treatment stages, a number of pitfalls and difficulties will be high lighted and advice and clinical protocols will be given, in order to ensure that the results of this im plant/prosthetic treatment are predictable and as aesthetically attractive as possible. This first article is concerned with these issues as regards the pre prosthetic stages; the second will consider the most important aspects of the prosthetic stages as well as aesthetic outcomes and their evolution over the long term. Anamnesis Once the usual contraindications for oral and implant surgery have been eliminated, particular attention should be given to the patient’s answers concerning their smoking habits. Indeed, meta- analysis give an accurate picture of the conse quences of smoking, with increases of: –– peri-implantitis1,2 and bone loss2 ; –– failure rates.3 The conclusions of Snider et al.4 can provide recommendations for the practitioner faced with a patient who is a smoker: –– 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. This last issue is important, as smoking can be considered a lost opportunity as far as implant treatment is concerned. “It is preferable to avoid patients that are smokers.” Clinical examination The smile line When replacing a tooth in an aesthetic region, understanding the location of the smile line is one 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, which can happen more or less as a con scious process and this can be a source of signif icant errors. Analysis of gingival composition is also a determining issue in positioning the collar of the lateral incisors in a location that is aesthet ically optimal. The gull-wing profile, where the collar of the lateral incisors is slightly more coro nal than that of the front teeth or the canine teeth, is considered to be more attractive accord ing to Chiche5 (Fig. 2). Dental aesthetics As regards dental aesthetics, the proportions of the proposed implant supported tooth can reflect two 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 Fig. 6: Simulation of location of 3 mm6 implant in cross section (case shown in Fig.1).6 Fig. 7: Evidence of radicular convergence. Fig. 8: Orthodontic layout of implant corridor. Fig. 6 Fig. 7 Fig. 8 Fig. 4 Fig. 5 1712016