Developing a transmucosal contour to achieve an optimal esthetic outcome in the esthetic zone
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Background: Successful implant restorations in the esthetic zone often require demanding surgical and prosthetic therapeutic procedures in order to achieve long term stable results. Anatomical factors such as the thin buccal bone plate, the thin soft tissues and the high scalloping further complicate the decision-making and the treatment workflow. Despite the clinical and scientific evidence the clinical handling and the treatment sequence and workflow is of outmost importance determining the final outcome of the implant restoration. Aim/Hypothesis: The purpose of this report is to describe a methodology and treatment workflow in esthetic implant cases. This treatment sequence is utilizing socket preservation and bone grafting, soft tissue augmentation and temporary restorations to achieve optimum esthetic results. Material and methods: A 30 year old female patient presented with a sugingivally broken central incisor. The root was extracted and ridge preservation, using FDBA and a resorbable membrane was performed. An etched bonded Rochette-type bridge was used to temporarily restore the missing tooth. At 4 months the bone volume of the augmented site was adequate and an implant was placed. A two stage approach was selected and the implant was covered for the osseontegration period. At 4 months the implant was uncovered and a simultaneous soft tissue augmentation using a connective tissue graft was performed. The palate was used as a donor site. A provisional screw retained implant crown was inserted. The provisional crown was utilized to enhance tissue maturation and scalloping by consecutive modifications that created the desired emergence profile in a period of 4 months. The emergence profile was captured via a customized impression procedure. A custom all-ceramic abutment capturing the developed emergence profile was constructed. An all-ceramic crown was used to create the final esthetic result. Results: The soft and/or hard tissue enhancement in the majority if not all of the cases in the esthetic zone is absolutely necessary in order to achieve a highly esthetic and natural appearance of the implant restoration. The dentist can progressively develop the site to accommodate the implant in a perfect position. The interim restoration can be utilized to create the ultimate emergence profile and to allow the patient to evaluate its shape, size and color during the tissue maturation period. A customized impression procedure is utilized to transfer all these information to the laboratory for the construction of the final restoration. Conclusion and clinical implications: This staged approach is a step-by-step procedure that allows the clinician to carefully design and execute all the necessary steps to achieve an optimal result. The transition from the existing dentition to the final one is smooth and allows the patient to evaluate the result as the treatment progresses. The patient has the opportunity to have a significant input in the final esthetic outcome. The drawback of this procedure is the extended period of treatment, although the patient has constantly a fixed and esthetic restoration to accommodate his/her needs.
European Association for Osseointegration
Dentistry not elsewhere classified