Maxillary Anterior Implant

Placement
By: Dr. Belal Awad Al- Ganadi.
CONTENT
*Maxillary Anterior teeth Evaluation.
*Anatomic Challenges.
*Surgical Protocol.
*Transitional Prosthesis.
*Complications.
 Introduction

In the aesthetic zone patient

expectation are high, and
satisfaction is of paramount
importance.
*Maxillary Anterior teeth Evaluation

When maxillary incisor single-tooth

replacement is to obtain an ideal
result, the clinician should evaluate
edentulous site and remaining
anterior teeth.
 *Maxillary Anterior teeth Evaluation

1) Maxillary tooth size:

Should appear symmetric and of similar
size.

Left central crown

Wider than right
Central incisor.
 *Maxillary Anterior teeth Evaluation

2) Tooth shape:
Biotype and soft tissue
thickness related to tooth
shape.
Long, triangular teeth
always come with a thin-
scalloped type and a thick-
flat type(with short, square
teeth).Patients with a thin-
scalloped biotype are
considered at ‘High
aesthetic risk’.
 *Maxillary Anterior teeth Evaluation

Bone modifications after tooth extraction

will be more pronounced for these
patients and patients with a thick-flat
biotype. Soft tissue integration of the
prosthetic restoration is easier and more
stable with thick tissues. As a result, soft
tissue augmentation is often
recommended for situations of high
aesthetic risk.
 *Maxillary Anterior teeth Evaluation

3) Soft Tissue Drape:

Patients with gummy
smile is one of the most
important criterion to
evaluate when
observing the cervical
region of the maxillary
anterior teeth.
 *Anatomic Challenges

1) Natural Tooth Size Versus Implant Diameter.

 *Anatomic Challenges

2) Compromised Bone Height.

 *Anatomic Challenges

3) Compromised Mesiodistal space.

 *Anatomic Challenges

4) Compromised Faciopalatal Width:

* Bone width (faciopalatal) should be at
least 3.0 mm greater than the implant
diameter.
* 25% bone loss in faciopalatal width
occurs within the first year of tooth loss
and 30% to 40% decrease within 3
years.
*Anatomic Challenges

Facial thin plate loss

 *Anatomic Challenges

5) Selection of Implant Size:

* Available space of missing tooth.

* Mesiodestal and faciopalatal

dimension.
 *Anatomic Challenges

Compromised bone
width:
(D) Tissue reflection
showing large osseous
defect, (E) autogenous
bone graft, (F) postgraft
healing.
*Anatomic Challenges

Large ridge defect

 *Anatomic Challenges

6) Implant Position.

* Mesiodistal position

* Faciopalatal position
 *Anatomic Challenges

6) Implant Position:
Anterior maxillary implants are positioned in
the middle of M D space and slightly palatal
to the faciopalatal space except the central
incisor implant is positioned slightly to the
distal of the M D space to avoid nasopalatal
foramen and canal injury.
*Anatomic Challenges

More distal position

 *Anatomic Challenges

Complete reflection of lingual tissue to

determine the position and size of the
nasopalatine foramen and canal.
 *Anatomic Challenges

7) Implant Body Angulation:

* Facial implant body angulation (more facial).

* Cingulum implant body angulation (more

palatal).

* Below the incisal edge.

 *Anatomic Challenges

Facial Implant
Body Angulation.
An angled abutment
is usually necessary.
There is force on the
angled abutment
lead to crestal
stresses to the bone
and abutment
screws.
 *Anatomic Challenges

Facially positioned implant leading to

compromised esthetics.
 *Anatomic Challenges

Cingulum Implant Body

Angulation.
Implant body more palatal,
used when:
*Facial bone loss.
*Screw-retained crown.
 *Anatomic Challenges

Implant placed in the

cingulum position will
usually require a ridge
lap on the implant crown
to restore the facial
contour of the tooth.
Ridge lap maybe lead to
compromised hygiene.
*Anatomic Challenges
*Anatomic Challenges

Compromised hygiene
 *Anatomic Challenges

Below Incisal Edge

Implant Body
Angulation.
Best used for a
cemented crown in the
esthetic zone.
*Anatomic Challenges

Ideal Implant Position

 *Anatomic Challenges

Presence of the papilla depends on

the presence of the interproximal
bone.
 *Anatomic Challenges

Implant be placed
approximated
(2 to 4 mm) apical to
the adjacent
cemento-enamel
junction (CEJ) or free
gingival margin
(FGM).
*Anatomic Challenges

Slightly palatal position

 *Surgical Protocol
-Immediate postextraction
implant placement.

or
-delayed after healing of socket.
 *Surgical Protocol
Immediate postextraction implant
placement:
Implant placement in a fresh socket
may preserve bone and soft tissue
more effectively than the delayed or
late implantation approach.
 *Surgical Protocol
Procedures of immediate
postextraction implant
placement:
-Atraumatic tooth
avulsion.
-Esthetically guided implant
placement taking into
consideration the anatomy
of the extraction socket.
*Surgical Protocol
*Surgical Protocol
*Surgical Protocol
*Surgical Protocol
*Surgical Protocol
*Surgical Protocol
 *Surgical Protocol

Note !
Positioning the
implant along the
original axis of the
extracted tooth lead
to fenestration of the
apical portion of the
thin buccal bone wall.
 *Surgical Protocol

Note !
More palatal axis,
should be avoided to
prevent later problems
with the prosthesis
and soft tissue
recession.
 *Surgical Protocol
Delayed implant placement after healing
of socket.
 *Surgical Protocol
In the one stage
the implant or the
abutment emerges
through the
mocoperiosteum
/gingival tissue at
the time of implant
placement.
*Surgical Protocol
*Surgical Protocol
 *Surgical Protocol
For enhancing the soft tissue
appearance:
1- Surgical ( addition or subtraction ).
2- Prosthetic.
 *Surgical Protocol
Surgical(addition or
subtraction).
Incision:
The incision is made
on the palatal
inclination to keep
thickness of
keratinized tissue on
the facial aspect of the
flap.
 *Surgical Protocol
Papilla-saving incisions when the
interdental papillae are intact.
 *Surgical Protocol
Alveolar Ridge Preservation and
Augmentation.

Extraction socket
 *Surgical Protocol
Alveolar Ridge Preservation and
Augmentation.

Bio-Oss collagen
 *Surgical Protocol
Alveolar Ridge Preservation and
Augmentation.

Collagen matrix
 *Surgical Protocol
Alveolar Ridge Preservation and
Augmentation.

Collagen matrix
 *Surgical Protocol
Alveolar Ridge Preservation and
Augmentation.
 *Surgical Protocol
Alveolar Ridge Preservation and
Augmentation.

Secure the matrix to the socket edges by

interrupted suture
*Surgical Protocol
*Surgical Protocol
*Surgical Protocol
Soft Tissue Augmentation
*Surgical Protocol
Soft tissue graft
*Surgical Protocol
 *Surgical Protocol
Prosthetic:
Reshaping of
contact position.
 *Surgical Protocol
Prosthetic:
A prosthetic
replacement of the soft
tissue with pink color
porcelain.
*Surgical Protocol
 *Transitional prosthesis
Soft tissue-borne transitional prosthesis
is not recommended because this may
increase:
- Crestal bone loss during the healing
period.
- Depress the interdental papilla of the
adjacent teeth.
 *Transitional prosthesis
For single tooth edentulous area:
- Hawley appliance with addition of a
denture tooth.
 *Transitional prosthesis
Single tooth replacement : removable
denture
 *Transitional prosthesis
Single tooth replacement : removable
denture
 *Transitional prosthesis
For multiple missing
maxillary anterior teeth,
a removable partial or
full arch prosthesis
retained by:
The remaining natural
teeth thereby preventing
pressure on the surgical
site or impingement on the
soft tissues overlying the
surgery.
 *Transitional prosthesis
- Restoration bonded to the adjacent
teeth.
 *Complications
1- Interdental papilla deficiency.
2- gingival shrinkage after crown
delivery.
 *Complications
Prosthesis solution:
Lower the
interproximal contact
of the crown by
reshaping the
adjacent teeth to
eliminates the
interdental space
caused by the lack of
papilla height.
*Complications
Esthetic failure
*Complications
Ridge preservation
 *Complications
Bone graft with double layer collagen
membrane
*Complications
Esthetic final result
 Thank you

By: Dr. Belal Awad Al- Ganadi.