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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
BUCCOLINGUAL IMPLANT POSITION AS A CONSEQUENCE OF THE ABUTMENT SHAPE — A paradigm shift Dr. Fabio Scutellà & Prof. Tiziano Testori, Italy — Dr. Fabio Scutellà Introduction — Prof. Tiziano Testori Implant rehabilitation in the esthetic zone, especially in the upper arch, has always posed a number of challenges. Although high survival rates for implants in this region are well established, the new con- cept of success that involves soft-tissue integration depends on several factors. The pink esthetic score, white esthetic score and implant esthetic score1-3 are indexes usually used to evaluate the esthetic success of an implant rehabilita- tion. Many factors play an important role in the esthetic outcome of any implant- supported restoration. Among some of the major keys to success are an awareness of the possibility of sudden resorption of the buccal plate (bundle bone), along with accurate 3-D implant planning and posi- tioning. Many publications have addressed the problem of buccal plate resorption4, 5 and a recent literature review6 investigated the magnitude of dimensional changes in alveolar hard and soft tissue occurring for up to 12 months after tooth extraction in humans. The review found that, six months after tooth extraction, horizontal bone loss ranged from 29 to 63%, and vertical bone loss ranged from 11 to 22%. If not promptly and correctly addressed, this phenomenon may compromise the final esthetic restorative result and even afect implant survival. Stability of the alveolar bone is paramount for maintain- ing the stability of the surrounding soft- tissue and guaranteeing a high level of esthetics over time. Regarding implant positioning, several papers have ofered guidelines regarding optimal 3-D positioning. However, since the most commonly used finishing line for restorative abutments is the horizontal type, guidelines for implant positioning have been conceived exclusively for that kind of geometry, but what if the abutment has a vertical rather than a horizontal fin- ishing line? The close relationship between the implant position, the abutment finishing line geometry, and the crown angles and contours is evident. The aim of this paper is, thus, to provide recommendations based on clinical evidence regarding the bucco- lingual implant position in the esthetic zone whenever a feather-edge (shoulder- less) abutment is chosen. In such cases, new guidelines should be taken into con- sideration to ensure a better soft-tissue response. 56 — issue 2017 Advanced Implant Esthetics Article