Open your vertical and smile, Part 2: Porcelain-fused-to-gold, full-mouth rehabilitation.
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Simultaneous removal of multiple adjacent teeth in the anterior maxilla often leads to collapse of the labial bony plate as well as flattening of the interproximal bony scallop, resulting in long implant restorations with missing interimplant papillae. An interimplant papilla preservation technique involving alternate immediate implant placement and provisionalization, one following the osseointegration healing period of the other, was introduced. All 14 implants placed in six consecutive patients maintained osseointegration after a mean functioning time of 22.6 months (range 12 to 34 months). A highly satisfactory esthetic outcome and a papilla index score of 3 was observed in all patients.
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The practice of implant dentistry requires an interdisciplinary approach that integrates the knowledge, skills, and experience of all the disciplines of dentistry into a comprehensive treatment plan. The team must examine the anticipated restorative site to determine the suitability of the existing hard and soft tissues for implant placement. Deficiencies in hard and soft tissue, which prevent ideal implant placement, must be recognized and addressed to ensure a more predictable esthetic outcome. This article outlines a comprehensive interdisciplinary treatment philosophy designed for developing the foundation of optimal esthetics in implant dentistry. Cases are presented to illustrate the utility of interdisciplinary treatment in which specialists are recruited to enhance and improve a patient's dental function and esthetics.
The use of dental implants continues to increase world wide, and single tooth replacement has evolved into a predictable procedure which is rapidly becoming the preferred method of tooth replacement. Clearly, there is increased awareness of and demand for esthetics in traditional restorative dentistry as well as implant-related care. Predictable delivery of highly esthetic, naturally appearing implant restorations is dependent on a host of factors, some of which are hardware-based and some of which are related to the morphology and tissue quality of the proposed implant site. An organized approach to patient evaluation and treatment planning by the implant treatment team will improve recognition of these factors of esthetic significance and will facilitate the development of strategies to achieve esthetic excellence on a more predictable basis.
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The metallic restorative materials of the past required the dentist to focus on function and form because metal had no tooth-colored properties. The development of tooth-colored restorative materials has introduced a new element in the restorative equation--color. Unfortunately, many clinicians continue to apply a "metallic mentality" to restorative techniques with the newer adhesive restorative materials that can produce a tooth-colored appearance. With advances in material sciences and adhesive technology, the restorative concept now includes aesthetics as a variable in the restorative equation as well.
As the biological width is established around neighboring implants, there is a flattening of the interimplant bone and a change in the position of the soft tissue. As a result, a normal progression of papilla from natural teeth through the adjacent implant area is lost. This presentation describes various techniques and strategies to improve the aesthetic outcome of anterior implant restorations, together with the use of a scalloped implant designed to sustain the interdental bony peaks, and in doing so, maintain the interimplant papillae.