Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics
Identifieur interne : 005C83 ( Ncbi/Merge ); précédent : 005C82; suivant : 005C84Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics
Auteurs : Andreas L. Ioannou [États-Unis] ; Georgios A. Kotsakis [États-Unis] ; Michelle G. Mchale [États-Unis] ; Donald E. Lareau [États-Unis] ; James E. Hinrichs [États-Unis] ; Georgios E. Romanos [États-Unis]Source :
- International Journal of Dentistry [ 1687-8728 ] ; 2015.
Abstract
Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon's rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.
Url:
DOI: 10.1155/2015/740764
PubMed: 26124837
PubMed Central: 4466380
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<front><div type="abstract" xml:lang="en"><p>Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon's rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.</p>
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<author><name sortKey="Van Hoof, T" uniqKey="Van Hoof T">T. van Hoof</name>
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</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Dent</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Dent</journal-id>
<journal-id journal-id-type="publisher-id">IJD</journal-id>
<journal-title-group><journal-title>International Journal of Dentistry</journal-title>
</journal-title-group>
<issn pub-type="ppub">1687-8728</issn>
<issn pub-type="epub">1687-8736</issn>
<publisher><publisher-name>Hindawi Publishing Corporation</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26124837</article-id>
<article-id pub-id-type="pmc">4466380</article-id>
<article-id pub-id-type="doi">10.1155/2015/740764</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Ioannou</surname>
<given-names>Andreas L.</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kotsakis</surname>
<given-names>Georgios A.</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>McHale</surname>
<given-names>Michelle G.</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lareau</surname>
<given-names>Donald E.</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="I2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hinrichs</surname>
<given-names>James E.</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Romanos</surname>
<given-names>Georgios E.</given-names>
</name>
<xref ref-type="aff" rid="I3"><sup>3</sup>
</xref>
</contrib>
</contrib-group>
<aff id="I1"><sup>1</sup>
Advanced Education Program in Periodontology, University of Minnesota, 515 Delaware Street SE, Minneapolis, MN 55455, USA</aff>
<aff id="I2"><sup>2</sup>
Private Practice, Edina, MN 55435, USA</aff>
<aff id="I3"><sup>3</sup>
Department of Periodontology, School of Dental Medicine, Stony Brook, NY 11794, USA</aff>
<author-notes><corresp id="cor1">*Georgios A. Kotsakis: <email>geo.kotsakis@gmail.com</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: Francesco Carinci</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2015</year>
</pub-date>
<pub-date pub-type="epub"><day>1</day>
<month>6</month>
<year>2015</year>
</pub-date>
<volume>2015</volume>
<elocation-id>740764</elocation-id>
<history><date date-type="received"><day>15</day>
<month>8</month>
<year>2014</year>
</date>
<date date-type="rev-recd"><day>2</day>
<month>11</month>
<year>2014</year>
</date>
<date date-type="accepted"><day>4</day>
<month>11</month>
<year>2014</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2015 Andreas L. Ioannou et al.</copyright-statement>
<copyright-year>2015</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon's rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth.</p>
</abstract>
</article-meta>
</front>
<floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Implants in the anterior maxilla: a clinical decision-tree for overcoming aesthetic challenges.</p>
</caption>
<graphic xlink:href="IJD2015-740764.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>(a) Patient had previous bone grafting and numbers 8 and 9 implant placement. Note minimal keratinized attached gingiva over grafted area of numbers 8 and 9 due to coronal advancement of the flap. (b) Note the deficient soft tissue profile following placement of a provisional prosthesis with appropriate tooth emergence. (c) Donor site and graft procurement. (d) Collagen tape and cyanoacrylate to reduce discomfort over donor site. (e) Graft secured and well adapted to recipient bed with multiple sutures. (f) Recipient site following healing. Note the increase in height and thickness of the keratinized attached gingiva. (g) Numbers 8 and 9 implant sites prepared for second stage surgery. (h) Recipient site after numbers 8 and 9 implant restorations, showing stable keratinized attached gingiva. (i) Lateral view of recipient site. Note the thick buccal keratinized attached gingiva, establishing an esthetic emergence profile for the implant restorations.</p>
</caption>
<graphic xlink:href="IJD2015-740764.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>((a), (b), and (c)) Patient presented for implant rehabilitation of number 7 lateral incisor. Not the high interdental smile line that poses an esthetic challenge. Following ridge resorption, a concavity consistent with a Seibert Class I defect is seen in the edentulous site. ((d), (e), and (f)) A block autograft was screwed in place to achieve horizontal ridge augmentation prior to implant placement. Particulated allograft was utilized to graft the area between the block and the recipient bed. Note the significant enhancement of the tissue profile postsurgically. ((g), (h), and (i)) At four months after grafting the site was reentered and an implant was placed in the ideal 3-dimensional position. A SCTG was utilized to replicate the root eminence and provide a natural emergence profile. ((j), (k), (l), and (m)) Postoperative healing view shows excellent tissue contours at the site. A customized healing abutment was selected to mold the tissues after 2nd stage surgery. Note the excellent positioning of the mucosal zenith at the time of provisionalization. ((n), (o)) Intraoral view of the final restorations in place. Crown lengthening was performed on the adjacent teeth to address the patient's overall esthetic demands. Note the excellent replication of gingival characteristics on the peri-implant mucosa and the natural appearance of the restoration as it emerges from the augmented hard on soft tissues at the site.</p>
</caption>
<graphic xlink:href="IJD2015-740764.003"></graphic>
</fig>
</floats-group>
</pmc>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Minnesota</li>
<li>État de New York</li>
</region>
</list>
<tree><country name="États-Unis"><region name="Minnesota"><name sortKey="Ioannou, Andreas L" sort="Ioannou, Andreas L" uniqKey="Ioannou A" first="Andreas L." last="Ioannou">Andreas L. Ioannou</name>
</region>
<name sortKey="Hinrichs, James E" sort="Hinrichs, James E" uniqKey="Hinrichs J" first="James E." last="Hinrichs">James E. Hinrichs</name>
<name sortKey="Kotsakis, Georgios A" sort="Kotsakis, Georgios A" uniqKey="Kotsakis G" first="Georgios A." last="Kotsakis">Georgios A. Kotsakis</name>
<name sortKey="Lareau, Donald E" sort="Lareau, Donald E" uniqKey="Lareau D" first="Donald E." last="Lareau">Donald E. Lareau</name>
<name sortKey="Lareau, Donald E" sort="Lareau, Donald E" uniqKey="Lareau D" first="Donald E." last="Lareau">Donald E. Lareau</name>
<name sortKey="Mchale, Michelle G" sort="Mchale, Michelle G" uniqKey="Mchale M" first="Michelle G." last="Mchale">Michelle G. Mchale</name>
<name sortKey="Romanos, Georgios E" sort="Romanos, Georgios E" uniqKey="Romanos G" first="Georgios E." last="Romanos">Georgios E. Romanos</name>
</country>
</tree>
</affiliations>
</record>
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