Multifaceted aspects of implant esthetics: the anterior maxilla

Preservation of Peri-Implant Papilla: A Narrative Review

Beside osseointegration and restoration of function, the patient's subjective satisfaction with the esthetic result is a touchstone of the success of implant therapy. The long-term maintenance and reconstruction of papilla-like soft tissue between two adjacent implants in the esthetic zone which is esthetically satisfactory is generally regarded as a challenge. The road to success is much more complicated with implants, because of biologic and anatomical limitations of peri-implant tissues. Numerous techniques have been proposed to manage the hard and soft tissues in an attempt to achieve ideal esthetic results which includes surgical and nonsurgical techniques. The goal of reconstructive procedures is to provide peri-implant bone that supports and maintains gingival contours. An interdisciplinary approach has an obvious advantage of long-term preservation of a healthy peri-implant tissue which is of key importance in ensuring acceptable function and subjective satisfaction of esthetics of dental implants. A detailed literature search was performed in English language from 1986 to 2012, which included review articles, original research, as well as case reports. The search was performed in National Library of Medicine's PubMed database, Google Search, and Science Direct. A manual search of hard copies of available journal was also performed using interdental papilla, peri-implant papilla, esthetics, and dental implant as key words, in an attempt to gain insight into the limitations of papilla preservation, the factors which may potentially affect the maintenance and reconstruction of inter-implant papilla, and the contemporary methods to augment it.

Immediate provisionalization and nonfunctional loading of a single implant in the maxillary esthetic zone: a clinical presentation and parameters for consideration

Restoration of single tooth loss with implant supported prosthesis is now considered a highly predictable treatment. However, the maxillary anterior region still presents a challenge for both the prosthodontist and the periodontist because of the inherent difficulties encountered in the provisionalization and harmonic incorporation of the definitive prosthesis into patient's dentogingival complex. This paper presents a clinical case of a single implant placed immediately after the extraction of a maxillary central incisor, followed by immediate provisionalization and nonfunctional loading. The surgical and the restorative techniques are described, and the parameters of consideration for this approach are presented.

Comportamento biomecânico do sistema prótese/implante em região anterior de maxila: análise pelo método de ciclagem mecânica

INTRODUÇÃO : O adequado posicionamento tridimensional dos implantes é indispensável para garantir a previsibilidade no tratamento com implantes dentários. OBJETIVO : Analisar comparativamente o comportamento mecânico do sistema prótese/implante em região anterior de maxila, diferindo os sistemas de encaixe e posicionamento dos implantes. MATERIAL E MÉTODO : Utilizando um modelo prototipado de maxila, as situações estudadas foram: Grupo IC - implantes nos incisivos centrais e cantilever nos incisivos laterais; Grupo IL - implantes nos incisivos laterais e pônticos nos incisivos centrais; Grupo ICIL - implantes no incisivo central e no incisivo lateral, intercalados com elementos suspensos. Para cada situação estudada, foram utilizadas as três conexões protéticas: hexágono externo, hexágono interno e cone-Morse. O ensaio de ciclagem mecânica foi realizado com a aplicação de 100 N de carga e frequência de 15 Hz no cíngulo dos incisivos a 45° com o longo eixo do dente, para simular o movimento mastigatório. RESULTADO : No ensaio de ciclagem mecânica, todos os modelos de todos os grupos com os três tipos de conexões protéticas atingiram um milhão de ciclos sem que ocorresse ruptura do parafuso, do componente protético ou da estrutura metálica. CONCLUSÃO : Com a metodologia e as condições empregadas, pode-se concluir que o comportamento mecânico das reabilitações implantossuportadas foi semelhante para os diferentes posicionamentos dos implantes e diferentes conexões protéticas.

Esthetics in implant-supported prostheses: a literature review

Esthetics is important for success of implant-supported prostheses. This study aimed to review esthetics concepts for implant treatment. Research in the PubMed database included studies published from 1995 to 2010 with the keywords implant esthetics, implant-supported prostheses, and esthetics. Forty-five studies were evaluated regarding the presurgical planning, surgical phase, and temporary and final restoration phases. It was concluded that esthetics in implant-supported prostheses results from a multidisciplinary approach from planning until insertion of the final restoration.

Planning for immediate loading of implant-supported prostheses: literature review

The aim of this study was to present the factors that influence planning for immediate loading of implants through a literature review for treatment success. Research was conducted in the PubMed database including the key words immediate implant loading, implant-supported prostheses, and implant planning for studies published from 2000 to 2011. Forty-eight articles were used in this review to describe the indications and counterindications, presurgical planning, and technologies available for planning of this treatment alternative.

The peri-implant esthetics: An unforgettable entity

Esthetic demands in today's world of dentistry are scaling new heights, and are driven by the zest to look beautiful. The soft tissue esthetics around implants is the foci of attention, which, if failed to meet, leads to unacceptable esthetic failure. The aim of this article is to give a brief overview of the various vital parameters influencing the esthetics governing the peri-implant area.

Evaluation of the Presence or Absence of Papilla between Tooth and Implant

Objective:

The purpose of this study was to evaluate the papilla level adjacent to single-tooth implants in the maxillary anterior region in individuals with cleft lip, alveolus, and palate to verify whether there is correlation among the vertical distance, horizontal distance, dental/prosthetic crown shape, and periodontal/peri-implant biotype with the presence of interproximal papilla.

Design:

Cross-sectional.

Setting:

Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP).

Patients:

77 papillae in 40 patients.

Interventions:

The periodontal/peri-implant biotype was clinically evaluated and characterized as thin or thick. Intraoral photographs were used to evaluate the presence or absence of papilla.

Main Outcome Measures:

Classification in scores (0 to 3) and determination of length (CL) and width (CW) of crowns adjacent to papillae. The CW/CL ratio was calculated for each crown in order to characterize it as square-shaped or triangular-shaped. The vertical and horizontal distances were obtained by radiographic evaluation.

Results:

The correlations between vertical distance and papilla score and horizontal distance and papilla score were statistically significant (p  =  .02 and p  =  .01). There was no significant difference between crown shape and periodontal/peri-implant biotype in distinct correlations with the papilla score (p  =  .41 and p  =  .07).

Conclusion:

The results suggest that the vertical and horizontal distances may have independent or combined relationship with the existence of interproximal papilla; the periodontal/peri-implant biotype (phenotype) was not correlated with the presence or absence of papilla, as well as the shape of the dental/prosthetic crown.

Restoration of the Soft-tissue Margin in Single-tooth Implant in the Anterior Maxilla

Esthetic requirements for dental implant restoration have arisen in recent years. Despite several surgical techniques that have been developed, the treatment of the peri-implant soft-tissue defect is still difficult. The purpose of this clinical article is to describe a grafting technique using subepithelial connective tissue grafts to recontour soft-tissue margin discrepancy for single-tooth implant restorations in the anterior maxilla. After 2-year follow-up, this procedure shows that the use of connective tissue grafts can be a predictable approach to establish new and stable peri-implant soft-tissue margin.

Peri-Implant Papilla Reconstruction: Realities and Limitations

In recent years, esthetic demands in dentistry have been climbing ever higher, driven by an enhanced awareness of beauty and physical appearance. Because gingival esthetics has become an important factor in the overall success of most implant-supported restorations, the loss of the peri-implant papilla leads to an esthetic handicap known as black hole disease. Today, one of the most challenging aspects of periodontal reconstructive surgery is to obtain a predictable peri-implant papilla in the esthetic zone. Starting with the facts about the morphology of the peri-implant tissues, to the various parameters influencing papilla reconstruction around implants, this article gives a brief overview of various papilla preservation and reconstruction techniques around implants.

A multidisciplinary approach to enhance implant esthetics: case report

Esthetic implant-supported restorations in the anterior maxilla present a number of clinical challenges to the dentist, including the need to preserve or restore the periimplant hard and soft tissue architecture around the implant site. In this clinical case report, two implant systems were used to restore two missing maxillary central incisors to make use of the physical properties in each system. Two different surgical protocols were used to place each implant, and the deficient alveolar bone was restored with an autogenous bone graft. After a detailed clinical evaluation, a comprehensive treatment plan was developed to address the unique demands of the patient. Both teeth were fully restored with esthetic, implant-supported, single-tooth restorations, and clinical results were recorded postoperatively.

Use of connective tissue grafts to enhance the esthetic outcome of implant treatment: a clinical report of 2 patients

The reestablishment of normal tissue volume, contour, and architecture around dental implants may require the use of osseous or soft tissue augmentation techniques. This article describes 2 patient treatments that highlight the use of connective tissue grafts to enhance the esthetic outcome of dental implant treatment.