Implant in Esthetic Zone

Implants in esthetic zone
Dr. Baleegh Abdulraoof Al-kadasi

introduction
In the esthetic zones, sufficient and

stable bone contours are desirable, and
gingival tissues of appropriate height,
shape, and contour are important
The success of oral rehabilitation with implants
depends on the integration of the components
with soft and mineralized tissues.
Esthetic considerations assume great importance in
most patients with missing anterior teeth.
This is an increasing challenge for the clinician
and is related to
1. the degree of coverage of the anterior

teeth (and gingivae) by the lips during normal
function and smiling.
2. the degree of ridge resorption, both
vertically and horizontally .
3. provision of adequate lip support
Components of Esthetic Examination
1- tooth positions,
2- gingival form,
3- osseous crest position,
4- Gingival biotype,
5- tooth shape,
6- Horizontal and vertical ridge deficiency
7- occlusal status all play an important role in
deriving an accurate esthetic treatment plan for the
patient.
 Smile line:
 A patient with a high smile line may show a buccal ridge
concavity under the restoration.
 Surgical augmentation by hard or soft tissue can reduce the
concavity.
 Another alternative includes the use of pink porcelain or
acrylic added to the final restoration
Tissue biotypes:
[Shape of teeth / Width & thickness of the
keratinized mucosa]
 Two different distinctive periodontal patterns
are present in the human oral cavity:
Thin scalloped biotype: (15%)
 thin friable gingiva with a narrow band of
attached mucosa and a thin flat bone that
usually exhibits dehiscence and fenestration.
 the tooth crown is triangular & the root is

narrow with taper the inter dental papilla is
thin and long.
Tissue biotypes:
 Thick flat biotype: (more prevalent 85%)
 Larger size square or rectangle teeth with a broader
more apically positioned contact and a cervical
convexity that has greater prominence
 embrassure is completely filled with the interdental
papilla tissues are dense fibrous with minimal height
difference & thick band of masicatory mucosa.
Shape Of Teeth And Tissue Biotypes
Tissue biotypes:
Clinical significance:
 Subepithelial C.T graft is often recommended
with the thin tissue biotype to improve quality
and thickness of tissue.
Interdental papilla
The supporting bone influences the establishment of

overlying soft tissue compartments and the bone
quality and quantity must be carefully assessed.
Interdental papilla
Interdental papilla
The effect of inter implant distance on the height of inter
implant bone crest
 3mm distance  Distance less than

Tarnow, cho, wallace 3mm
J periodontol april 2000
Height of inter proximal bone crest
between implant and natural tooth
Tarnow, cho, wallace

J periodontol april 2000
Gingival Dimensions And Periodontal Health
 an"adequate" zone of gingiva was considered

critical for the maintenance of marginal tissue
health and for the prevention of continuous
loss of connective tissue attachment
Diagnostic wax-up for treatment
planning.
A diagnostic wax-up is often required, especially in cases involving

placementof multiple implants.
Implant placement
 According to these guidelines, the surgeon should:
1. Employ a conservative flap design;
2. Evaluate the existing bone and soft tissue;
3. Time the placement correctly;
4. Visualize the three-dimensional position of the implant;
5. Consider healing time before implant loading;
6. Consider the determinants of emergence profile; and
7. Select a proper abutment and final restoration design.
Incision
Proper location and angulation
A surgical template
– Indicate the incisal edge position of final
restoration
– Helps determine proper implant location
and angulation
Implant positioning in the esthetic zone
Implant positioning in the esthetic
zone
Implant positioning in the esthetic zone
Buccolingual position of implant.
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DSCF0607
Timing of implant placement following
tooth removal
Depending On The Buccal Bone And Buccal Gingival Margin
Relationship (Elian Et Al., 2007; Saadoun And Landsberg, 1997), Four
Clinical Situations May Exist Andwill Determine
The Extraction Site Classification/Implant placement Timing/Implant
Loading :
• Class Ia. the buccal bone level is in the correct position at 3 mm from the buccal
gingival margin with the thick biotype.
• Class Ib. the buccal bone level is in the correct position at 3 mm from the buccal
gingival margin with the thin biotype.
• Class II. the buccal bone level is more apical beyond 3 mm (dehiscence or bone
resorption) from the buccal gingival margin at the normal level with thick or thin
biotype.
• Class III. the buccal bone level is more apical beyond 3 mm from the buccal gingival
margin with a gingival recession.
Timing of implant placement following
tooth removal
Type of abutments
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Implants in esthetic zone

Dr. Baleegh Abdulraoof Al-kadasi

In the esthetic zones, sufficient and

1. the degree of coverage of the anterior

 the tooth crown is triangular & the root is

The supporting bone influences the establishment of

 3mm distance  Distance less than

Tarnow, cho, wallace

 an"adequate" zone of gingiva was considered

A diagnostic wax-up is often required, especially in cases involving

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