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today EAO Paris Sep. 30 & Oct. 1, 2016

science & practice 25th EAO Annual Scientific Meeting 15 You have the know-how. The Osstell IDx helps you to objectively determine implant stability and to assess the progress of osseointegration – without jeopardizing the healing process. It is an accurate and non-invasive method that will provide the objective informationneededtodeterminewhentoloadtheimplant. Less guesswork. More Insight. Now get the know-when. Meet us in booth S18 | EAO Congress AD Author Dr Philippe Russe formerly worked as an assistant at the Reims University Hospital and now works at a private practice in Reims, France. He can be contacted at Prof. Patrice Margossian is former director of the implanto- logy department at the Marseille University Hospital and works at a private practice in Marseille, France. He can be contacted at ment, balanced anterior guidance for the central incisors and the canines will be one of the major objectives for the orthodontist. If there is bilateral agenesis, the symmetry of the smile will be maintained and the situation will be esthetically more favorable than for a unilateral replacement. Af- ter some years, the discrepancy may become quite significant and may be present just in the vertical plane or may be a combination, both vertical and horizontal (Figs. 19a–c). It was thought that this phenomenon was the result of placing implants too early, but in 2004 Bernard et al.37 showed that there was no difference between a group of young adults and a group of adults in terms of infraoc- clusion of implant-supported crowns in the esthetic region. In describing the problems found in implantsup- ported anterior restorations (bluish gingiva, infraocclusion, exposure of abutment), Zachrisson38 poses the question: Is an implant the best solu- tion 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 patients over a period of 17–19 years, showed that severe infraoc- clusions (> 1 mm) affected 35 % of the patients. They made several findings, including the following: – Women were affected more than men. – It was more noticeable in long rather than short faces. – There was no correlation with age. – The patients were more satisfied with the results than were the practitioners. The findings of the same re- searchers were presented at the 2012 Academy of Osseointegration annual meeting in Phoenix, AZ, US, by Torsten Jemt, who attributed im- plant-supported crown infraocclu- sions to posterior mandibular rota- tion resulting in verticalization of natural incisors that is not followed by the crowns on the implants. In the results reported, 19 out of 69 cases presented infraocclusions of more than 1 mm and the phenome- non affected twice as many women as men. A recommendation has been made by the practitioners of the Brånemark clinic in Gothenburg, Sweden, to place implants in a pala- tal position in anticipation of possi- ble verticalization of the central in- cisors. Such placement also facili- tates any prosthetic adjustment.39 Favor a palatal positioning of implants Conclusion Replacement of a lateral maxil- lary incisor is a difficult task. The great visibility of the tooth in the smile and comparison with the con- tralateral tooth in the same view are factors with intrinsic esthetic risks. In both parts of this article series, emphasis has been placed on the most difficult situations when the lateral incisor is small. In such cir- cumstances, any lack of precision in the positioning has powerful im- plica- tions for the esthetic plan. In this situation, using small-diameter implants would appear to offer ad- vantages for the height of the papil- lae around the implant. In about one-third of cases, con- tinuous maxillary eruption under- mines the initial esthetic outcome, which may result, at the very least, in having to change the crown on the implant. This change to the es- thetic outcome should form part of the information provided to patients before starting treatment.40 Editorial note: A list of references is available from the publisher. Conflict of interest: The authors de- clare that they have no conflict of in- terests relating to this article. 5 Fig. 17a: Initial situation. 5 Fig. 17b: After three years, the papillae are slightly longer. 5 Figs. 18a & b: Smile of female patient in 1998 (a). Smile of female patient in 2014. Egression of natural teeth (b). 5 Figs. 19a–c: Smile of female patient in 2001 (a). Clinical sit- uation in 2013 (b). Verticalization and egres- sion of central incisors, lateral view (c). Fig. 17a Fig. 17b Fig. 18a Fig. 18b Fig. 19a Fig. 19b Fig. 19c