前牙美學(xué)區(qū)種植

Treatmentplanningofimplantsintheaestheticzone●Thepredictabilityofaestheticsuccessdependsontissuelossattheinitiationoftreatment.

●Specificimplantsystemsanddesignsdonoguaranteeaestheticoutcomes.

●Hardandsofttissuedeficienciesmustbeaddressedpriortoimplantplacement.

●Recreatingpapillabetweenmultipleadjacentimplantsisnotpredictable.Inthelast10yearsthefocushasshiftedfromosseointegration,tocreationofanimplantbornerestorationwhichisinharmonywiththesurroundinghardandsofttissue..

Replacementofmultiplemissingteethin

theaestheticzoneischallengingparticularly

whenthethreedimensionalarchitectureofthe

existingboneandsofttissueisdeficient..

Thereisnotasinglecomponentavailablefromamanufacturerwhichwouldbetheidealreplacementforamaxillarycentralincisor..Thepredictabilityoftheaestheticoutcome

ofanimplantrestorationisdependentonmany

variablesincludingbutnotlimitedtothefollowing:

1)Patientselectionandsmileline

2)Toothposition

3)Rootpositionoftheadjacentteeth

4)Biotypeoftheperiodontiumandtoothshape

5)Thebonyanatomyoftheimplantsite

6)Thepositionoftheimplant.1.Patientselectionandsmileline

Notice:

Theclinicianmustunderstandthepatient’sdesires.

Theaestheticzoneiswherethepatientthinksitis.

Theclinicianshouldbeawarethatthepatientwhopresentswithunacceptabletoothhealth,shadeor

positionmaynotgiveafullsmilewhenasked.

2.Toothposition

Inmanyinstancesteethwithapoorprognosisarethoughtlesslyextracted.

Apico-coronal:moreapical,morecoronaloridealandmimictheleveloftheadjacentgingivalmargin.

orthodonticextrusion

Facio-lingual:positionedtoofarfacially,boneaugmentationprocedures;

positionedmorelingually,morefavourable

Mesio-distal:beequaltothatofthecontralateraltooth;orthodontics,enameloplastyorrestorations3.Rootpositionoftheadjacentteeth

decreasetheverticalboneheight,harmproximalgingivalarchitecture

orthodonticstorepositionmalposedteeth4.Biotypeoftheperiodontiumandtoothshape

BiotypeⅠ:

Athinbiotypewillrequiretheimplantbodyandshouldertobeplacedmorepalataltomaskanytitaniumshowthrough.

Whenimplantsareplacedtowardthepalatea

slightlydeeperplacementisrequiredtoallow

forproperemergenceprofile

BiotypeⅡ:

Ideallythefacialcontourshouldbeslightlyflatterthanthecontralateralnaturaltoothtominimiseapicaldisplacementofthefreegingivalmarginafterinsertion.

5.Thebonyanatomyoftheimplantsite

Thedefinitiveimplantrestorationneedstobesurroundedbyahardandsofttissueenvironmentwhichisinharmonywiththesurroundingdentition

Adiagnosticwaxuphighlightingtissuedeficienciesandfinaltoothpositioningcanassistintheplanningprocess①Facio-lingualridge

②Mesio-distalspace

③apicocoronaldimension

apicocoronaldimension

●Heightandthicknessoffacialbonywall

theverticaldistanceofthedentogingivalcomplexonthemidfacialaspectis3mm,aslightapicallossoftissueupto1mm.Greaterorlesserthan3mmindicatesthechangewillberelativelynegligibletomorethan1mm.

●Heightofbonycrestintheinterproximalarea

theheightofperi-implantpapillaeinsingletoothgapsisindependentoftheproximalbonelevelnexttotheimplantbutisdependentontheinterproximalboneheightoftheadjacentteeth6.Thepositionoftheimplant

Ifthetoothtobereplacedhasnotyetbeenremoved,severaldeterminationsshouldbemadepriortotheextractionApico-coronalplacement

Theapico-coronalpositioningoftheimplantistheverticaldiscrepancybetweentheocclusalsurfaceoftheimplantandthepeaksofthebonyseptaproximaltotheadjacentteeth,themostpleasingaestheticresultoccurswhenthisdiscrepancyisminimal.

Averticaldistanceof3-4mmisneededforgradualtransitionfromthe4mmdiameteroftheimplantplatformtothe7-8mmdimensionatthegingivalmargin。Mesio-distalplacement

Poorembrasureformandemergenceprofile

willresultinarestorationwithalongcontact

zoneandcompromisedclinicaloutcomesFacio-lingualplacement

?Thecrestwidthneedstobeexaminedto

determinethepresenceorabsenceofbone

atrophy.

?Placementwillvarydependingonthemechanism

ofretentionofthefinalrestoration

(screwretainedvs.cementretained).

?Deficientalveolarcrestwidthmayrequire

augmentationsothattheimplantcanbepositioned

inthecorrectfacio-lingualposition.Considerationsformultipleimplants

whentwoimplantsareplacedadjacenttoeachotherintheaesthet