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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
Fig. 1a Fig. 1b Fig. 1c Figs. 1a–c (a) In the mesiodistal direction, the implant should be placed 1.5–2.0 mm from adjacent teeth and 3.0 mm from other implants. (b) In the apicocoronal direction, the implant position should be 2–4 mm below the midfacial aspect of the free gingival margin. (c) In the buccolingual direction, the implant should be placed palatal to the incisal edge. Implant position in the esthetic zone The optimal implant position and diameter for the esthetic zone have been investi- gated extensively, with many authors pro- posing diferent approaches. Buser et al., attempting to identify the ideal implant position, stated that, in the mesiodistal dimension, the implant should be posi- tioned no closer than 1.0–1.5 mm to the adjacent root surface(s);7 between two adjacent implants, the mesiodistal distance should be within 3.0 mm. However, when applying platform-switching, placement of implants closer than 1.5 mm to the adjacent tooth has been deemed accept- able and capable of maintaining the bone peak.8 In the apicocoronal direction, Tarnow’s assumption that “a maximum of 5 mm distance from the alveolar crest to the contact point is necessary to obtain cor- rect soft tissue esthetics in natural teeth”9 has been verified also for implants.10 Cho- quet stressed the importance of the api- cocoronal position for preserving papillae and found in a retrospective study that, when the distance between the contact point and the bone was 5 mm, the papilla was present in 100% of the cases. More properly, the platform of the implant should be located 2–4 mm below the midfacial aspect of the free gingival mar- gin.11 Bashutski12 and Grunder13 agree that, in the buccopalatal dimension, the implant should be inserted to preserve at least 2 mm of buccal bone. Factors affecting mucosal recession around single-tooth immediate implants have also been evaluated in a systematic review.14 The authors suggested that, in highly esthetic cases, undersized implants should be selected and placed at the cin- gulum to enhance soft- and hard-tissue growth (Figs. 1a–c). Importance of the biotype One prerequisite for managing implant restorations in the esthetic zone is the presence of thick soft tissue surrounding the implant. Gingival biotype is used to describe the thickness of the gingival tissue in the faciopalatal dimension and it is clas- sified into two main categories: thin and thick.23 The diference between the two biotypes is defined by the visibility of a periodontal probe through the gingival tissue: If it is visible, the biotype will be regarded as thin; if it is not visible, it will be classified as thick. A study performed by Kan et al. analyzed the dimension of the periimplant mucosa around two-stage maxillary anterior single- tooth implants in humans after one year of function. The study showed a greater Article Advanced Implant Esthetics issue 2017 — 57