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Aesthetic Implant Treatment

A successful implant treatment is determined by taking into account a number of factors:

  • The management of hard tissue (bone)
  • The management of soft tissue (gum)
  • The quality of the prosthetic restoration
  • The response to the aesthetic demand

but above all precision in implant positioning.

Implant treatment can be represented by a pyramid, on top of which is the aesthetic treatment. Implant treatment in general represents the base of this pyramid. It should be noted that all patients to be treated are not at the top of this pyramid, because often, function (chewing) prevails.
An aesthetic treatment will be more complicated, take more time and efforts and also be more expensive.
All patients are not candidates for optimal aesthetic treatment. Similarly, all practitioners are not able to conduct this type of treatment in their entirety.
At the base of implant treatment is the hard tissue (bone). The implant is a screw that is fixed into the bone and will anchor a fixed prosthesis (crown, bridge). It is therefore essential before any treatment to assess carefully the quality and quantity of bone. The number and position of these implants is dependent on these two parameters.

So with a bone of a low density in the presence of high occlusal forces (chewing), one will need more implants than with a dense bone of good quality.

This is also why in some cases bone grafts may be needed to reinforce the base and insert implants with a good long-term prognosis.On top of the bone are soft tissues (gingiva), they cover the bone and make the junction between the exterior and the interior in the presence of implants. The titanium implant, perfectly welded to the bone is also well tolerated by the gingival tissues.
In the case of high aesthetic demands, we must consider:
  • The shape, color and texture of the gingival tissues
  • The presence of papillae between the teeth in order to give a natural look to the implant restoration.

The last point to consider is the precision in implant positioning.

A millimeter, 10 degrees in some cases may tip the treatment’s success to failure and vice versa.

When treating fully edentulous patients treatment, precision is not essential (function is needed first). The accuracy of the surgical procedure becomes critical in the case of partial edentulism (several missing teeth) or unitary (a single missing tooth) mainly in the anterior maxilla.

Classification:

Drs Patrick Palacci and Ingvar Ericsson (Gothenburg – Sweden) have designed and presented a classification now recognized worldwide for evaluating cases to be treated according to the resorption of hard tissue, soft, and the interdental papillae, highlighting the difficulty for “restitutio ad integrum” in some specific clinical situations.

Class 1

Class 2

Class A

Class B

Class 3

Class 3

Class 4

Class 4

Class C

Class C

Class D

Class D

This classification can be used by the surgeon, the specialist in prosthodontics and even the patient who understands and that a class A1 case will be infinitely easier to treat a class C 3 case for example. (In this situation, bone and soft tissue augmentation are needed to obtain an optimal functional and aesthetic result). The cases presented show various clinical situations and their implant solutions.

 

Anterior maxillary cases:

Replacement of two congenital missing lateral incisors (agenesis) implant supported restoration.

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17 ans

17 ans

17 ans

Final result after orthodontic treatment to restore adequate space between the teeth in order to place two implants at position 12 and 22.

Long-term outcome (17 years) front view, side, and the smile of the patient. High smile line, high mobility of the lips.