Anterior Implant Esthetics

The first decision to make is whether the failing tooth is needed for implant site development. The failing tooth may be useful in situations where significant bone loss is associated with the failing tooth but not with adjacent teeth. If one extracts the tooth, the bone level may be more apical relative to the adjacent teeth. This creates a difficult situation for impression taking and implant-supportive maintenance. As plaque accumulates at the implant interface, the inflammation may adversely affect the periodontal status of adjacent teeth. The ideal treatment is to delay the extraction so the failing tooth can be orthodontically extruded. As this is done over the course of six months, the bone and periodontal attachment surrounding the failing tooth will be coronally positioned to match adjacent bone levels. This provides more ideal bone height and allows the restorative implant platform to be placed at the desired height of 3 to 4 mm subgingivally. This section will focus on situations where the failing tooth needs to be extracted and define key determinants for preserving hard and soft tissue for an optimal implant-supported prosthesis.
There are several factors to consider when planning an implant restoration of failed dentition in the esthetic zone. Most often, the esthetic zone involves the maxillary anterior dentition. Although the single-tooth implant-supported restoration appears simple to perform, it is the most challenging in the esthetic zone. One of the initial assessments is determining if the tooth in question is a candidate for immediate implant replacement or a ridge preservation procedure.
The following checklist of nine issues will be discussed.
* Assessment of patient expectations;
* Assessment of gingival display;
* Gingival thickness;
* Papilla presence or absence;
* Morphology of adjacent teeth (crown-to-root ratio);
* Size and shape of contact areas of adjacent teeth;
* Available bone height;
* Available bone width; and
* Studies appropriate for final decision making.












Clinical Considerations for Increasing the Esthetic for Anterior Single-tooth Implant Restorations
1. Bone volume-quality and contour
2. Proximity of anatomical structures
3. Gingival morphology-facial and interproximal
4. Periodontal prognosis of adjacent teeth
5. Mesiodistal width of edentulous space
6. Interocclusal space
7. Implant size and site
8. Custom provisional prosthesis and abutment
9. Oral hygiene, etc.