Implant position: Its effect on implant aesthetics and health

1. Dr Steven Soukoulis Implant position: Its effect on implant aesthetics and health

2. SPECIALIST CASES

3. Goal • Implant crown should occupy same 3D space as original crown The implant position should allow this goal to be realised • Implant crown and gingival complex should replicate original architecture

4. FACTORS AFFECTING IMPLANT POSITION ANATOMICAL FACTORS PROSTHETIC FACTORS

5. Implant position • Anatomical structures; • bone, gingival tissues, lips, adjacent teeth, surgical skill/technique, implant type • Prosthetic considerations; • type of restoration (single/multiple), screw retained or cement on, posterior or anterior, crown or precision attachment

7. Aesthetics • Various anatomical structures can be used as reference points when trying to determine how the proposed prosthesis would satisfy the aesthetic demands of the site and patient. • This pre-surgical assessment is paramount to establishing a good position of the dental implant

8. Pre-Surgical Assessment SMILE LINE GINGIVAL MARGIN MIDLINE CROWN LENGTH CROWN WIDTH

10. Aesthetics • Maxillary incisor inclination • Evaluate the labio-lingual inclination of the maxillary anterior teeth • This can be done using: • cephalometric radiographs or • patient’s maxillary posterior occlusal plane • Generally, the labial surface of the maxillary central incisors should be perpendicular to the occlusal plane allowing maximum direct light reflection from the central incisors (Kokich et al 1997)

12. Insert daryl here

13. Aesthetics • Gingival considerations: • The ideal gingival levels are determined by establishing the correct width-to-length ratio of the maxillary anterior teeth (Sterrett et al 1999) • By determining the desired amount of gingival display • By establishing symmetry between right and left sides of the maxillary dental arch (Kokich et al1999) 80%

14. Perceptions of dental professionals and Lay persons to altered dental esthetics: Asymmetric and symmetric situations Vincent O. Kokich, Vincent G. Kokich,H. Asuman Kiyakc (Am J Orthod Dentofacial Orthop 2006; 130:141-51)

15. 100% 80%

16. Crown Lengthening

17. Aesthetic assessment • Maxillary tooth aesthetics • appraisal of the position of the maxillary central incisors relative to the upper lip • Determination of midline relationship/position

19. SURGICAL CONSIDERATIONS

20. Standard vs. ESTHETIC PLUS Standard implant ESTHETIC PLUS implant 1.8 mm 2.8 mm

21. ESTETHIC PLUS Implant

22. ≥ 5.5 mm ≥ 6.2 mm ≥ 6.2 mm S  4.1 mm WB  4.8 mm WNI  4.8 mm

23. ≥ 4.8 mm ≥ 4.8 mm NNI  3.3 mm S  3.3 mm

27. Ideal Implant placement in biotype I

28. Ideal Implant placement in biotype II

29. Biotype Type 1 Type 2

30. Predicted gingival margin

33. With these assessment criteria/protocols lets look at several cases to determine how to approach these to ensure a good aesthetic and peri-implant health result.

34. HOW NOT TO DO IT!

35. TOO DEEP TOO BUCCAL

36. Mc DENTISTRY

37. HOW DO YOU DO IT?

47. GOOD POSITION BUT PROSTHETICS?

50. TOO DEEP