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Implant position: Its effect on implant aesthetics and health - PowerPoint PPT Presentation


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Dr Steven Soukoulis. Implant position: Its effect on implant aesthetics and health. SPECIALIST CASES. Goal. Implant crown should occupy same 3D space as original crown. The implant position should allow this goal to be realised.

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Presentation Transcript
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Dr Steven Soukoulis

Implant position: Its effect on implant aesthetics and health

slide3

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
slide4
FACTORS AFFECTING

IMPLANT POSITION

ANATOMICAL

FACTORS

PROSTHETIC

FACTORS

slide5

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
aesthetics
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
pre surgical assessment
Pre-Surgical Assessment

SMILE LINE

GINGIVAL MARGIN

MIDLINE

CROWN LENGTH

CROWN WIDTH

aesthetics1
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)
aesthetics2
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%

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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)

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100%

80%

aesthetic assessment
Aesthetic assessment
  • Maxillary tooth aesthetics
    • appraisal of the position of the maxillary central incisors relative to the upper lip
    • Determination of midline relationship/position
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Standard vs. ESTHETIC PLUS

Standard implant

ESTHETIC PLUS implant

1.8 mm

2.8 mm

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≥ 5.5 mm

≥ 6.2 mm

≥ 6.2 mm

S  4.1 mm

WB  4.8 mm

WNI  4.8 mm

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≥ 4.8 mm

≥ 4.8 mm

NNI  3.3 mm

S  3.3 mm

biotype
Biotype

Type 1

Type 2

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Predicted

gingival margin

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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.

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TOO DEEP

TOO BUCCAL

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GOOD POSITION

BUT

PROSTHETICS?

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In Summary
  • Pre-surgical assessment should carried out prior to implant placement
  • Use surgical guides where possible
  • Consider temporary implant crowns in high aesthetic zones
  • NEVER bury implants