Scribd Logo
Upload

Welcome to Scribd!

  • 552ab1769123c899aed1653c45904173

    Uploaded by

    YassinSalah
    10 views71 pages
    pdf for selection

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    pdf for selection

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    10 views71 pages

    552ab1769123c899aed1653c45904173

    Uploaded by

    YassinSalah
    pdf for selection

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    of 71
    Anterior Implant Esthetics: Building the Foundation First Mondays Study Club Robert C. Cain, DDS March 3, 2014 Objectives * To understand the differences between implants and natural teeth and how these differences can effect esthetics ¢ To understand the factors associated with hard and soft tissues around implants that can effect the outcome of the restoration * To understand some of the different techniques that can be used to achieve hard and soft tissue goals Questions * Why are implant esthetics often more challenging than natural teeth? * What can we do to ensure the best possible esthetic and functional outcome? ¢ What do we tell a patient who needs one or more teeth replaced in the esthetic zone? Advantages of Implants Implants preserve bone and soft tissue just as a natural tooth would. Implants do not rely on adjacent teeth for support Implants do not decay Implants appear to be less susceptible to periodontal diseases than natural teeth Looks, acts and feels like the real thing often does not cover implant Wigecraecs efter) Nace) nnlmaa (Muted gS) grafting techniques Differences between Implants and Natural Teeth ELT md) Roots made of cementum and dentin Ovoid in cross section Connection to bone by periodontal ligament aye raid Connective tissue attachment 5 to cementum Gingival fibers run perpendicular to tooth surface Made of Titanium with textured surface Round in cross section Direct connection to bone by osseointegration No connective tissue Laer ne eine Miles Reiese1e Natural Teeth Roots made of cementum and dentin Ovoid and cross section Connection to bone by periodontal ligament eT Tat dere kl ac-log lupe to cementum Gingival fibers run perpendicular to tooth eT elo Implants Made of Titanium with ‘ auc conte a r-[e } Round in cross section Direct connection to bone by osseointegration No connective tissue attachment Gingival fibers are circular AAAALAAG |, Considerations Tissue Biotype — Thick or Thin? Smile Line — High or Low? Amount of Tissue Scallop — High or Low? Interproximal Bone Levels — Normal or Reduced? Facial — Lingual Bone Dimensions — adequate or reduced. How much is enough? Considerations Bone Loss Around Tooth/Teeth to be Replaced? Amount of Infection Around Tooth/Teeth to be Extracted Restorations on Adjacent Teeth — could effect the overall outcome Patient Expectations! How do we get the best possible outcome? * Careful Treatment Planning — Study models (diagnostic waxups), x-rays (including CBCT), photos, occlusal analysis * Preserve Hard and Soft Tissue — Atraumatic extractions, Immediate implant placement where possible — Bone and soft tissue grafting to rebuild lost tissue — Proper provisional design * It’s the surgeon’s job to build the foundation for the restoration How do we get the best possible outcome? * Proper Implant Placement — Must allow for ideal emergence profile, functional occlusion and esthetic contours * Understand Limitations of Tissue Contours around Implants — What determines papillae height and shape — Use of ovate pontics where needed _ si The Soft Tissue Around the Implant ily the Buccal Tissue and the roximal Papillae 1e Tissue Is The Issue” How Do We Know Whether We Will Have.a Papilla? * Two Scenarios — Implant — Implant — Implant — Tooth * Aseries of articles by Dennis Tarnow Sem M tila wee em ee Mee ae aCe nT Crest of Bone on the Presence or Absence of the Interproximal Dental Papilla, J. Perio 1992; 63:995-996 See Clae( MMe lM ine iminl-A Sg aelm -el Mom Ms lal 9 Cea eerie Cw ded- nec Eig Implants. J. Perio 2003; 74: 1785-1788 How Do We Know Whether We Will Havea Papilla? * In 1992 Tarnow, et al. showed complete papillae formation if NelOM aro Mel ie laa-Kold 5mm or less from the interproximal contact point to the crest of the interproximal bone between teeth. How Do We Know Whether We Will Havea Papilla? * In 2003 Tarnow showed that only 2-—4mm of papillae height can lol=M =) el-[ainele| between two hil Eee . How Do We Know Whether We Will Have a Papilla? Fortunately, lol=]aWvcto1 ane] a) implant and a tooth, the papillae behave the same as between two teeth. The tooth supports the soft aisles Treatment Options — Tooth Present * Extraction with Immediate Placement — Immediate fixed provisionalization — Delayed fixed provisionalization * Extraction with Delayed Placement — Ridge preservation/regeneration — Provisionalization — Placement with fixed provisionalization Treatment Options — Tooth Missing * Delayed Placement — Hard and/or soft tissue regeneration — Placement with provisionalization Immediate Placement — Simultaneous hard and soft tissue regeneration — Immediate or Delayed Provisionalization _ - * Preserving bone and soft tissue at time of er lsra rating lost hard and soft tissue papillae using provisional restoration | Preserve Hard and Soft Tissue ¢ Atraumatic extraction using Benex Extractor Benex Extraction System Ridge preservation with Benex www. benex-dent.com Benex Extraction System Benex Extraction System — Extraction with Immediate * Pilot hole prepared into root canal'space * Anchor is attached to goles CMM) cree leh Init l

    You might also like