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Dr Steven Soukoulis. Implant position: Its effect on implant aesthetics and health. SPECIALIST CASES. Goal. Implant crown should occupy same 3D space as original crown. The implant position should allow this goal to be realised. - PowerPoint PPT Presentation
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Implant position:
Its effect on implant aesthetics and health
Dr Steven Soukoulis
SPECIALIST CASES
Goal
Implant crown should occupy same 3D space as original crown
Implant crown and gingival complex should replicate original architecture
The implant position should allow this goal to be realised
FACTORS AFFECTING IMPLANT POSITION
ANATOMICALFACTORS
PROSTHETICFACTORS
Implant position
Anatomical structures; bone, gingival tissues, lips, adjacent teeth, surgical skill/technique, implant type
Prosthetic considerations; type of restoration (single/multiple), screw retained or cement on, posterior or anterior, crown or precision attachment
Aesthetics
Various anatomical structures can be used as reference points when trying to determine how the proposed prosthesis would satisfy the aesthetic demands of the site and patient.
This pre-surgical assessment is paramount to establishing a good position of the dental implant
Pre-Surgical Assessment
SMILE LINE
GINGIVAL MARGIN
MIDLINE
CROWN LENGTH
CROWN WIDTH
Aesthetics
Maxillary incisor inclination
Evaluate the labio-lingual inclination of the maxillary anterior teeth
This can be done using: cephalometric radiographs orpatient’s maxillary posterior occlusal plane
Generally, the labial surface of the maxillary central incisors should be perpendicular to the occlusal plane allowing maximum direct light reflection from the central incisors (Kokich et al 1997)
Insert daryl here
Aesthetics Gingival considerations:
The ideal gingival levels are determined by establishing the correct width-to-length ratio of the maxillary anterior teeth (Sterrett et al 1999)
By determining the desired amount of gingival display
By establishing symmetry between right and left sides of the maxillary dental arch (Kokich et al1999)
Tooth Width Length Ratio (%)
Central
Incisor
8.59 mm (M)
8.06 mm (F)
10.19 mm (M)
9.39 mm (F)
0.85 mm (M)
0.86 mm (F)
Lateral
Incisor
6.59 mm (M)
6.13 mm (F)
8.70 mm (M)
7.79 mm (F)
0.76 mm (M)
0.79 mm (F)
Canine
7.64 mm (M)
7.15 mm (F)
10.06 mm (M)
8.89 mm (F)
0.77 mm (M)
0.81 mm (F)
80%
Perceptions of dental professionals and
Lay persons to altered dental esthetics:
Asymmetric and symmetric situations
Vincent O. Kokich, Vincent G. Kokich,H. Asuman Kiyakc (Am J Orthod Dentofacial Orthop 2006; 130:141-51)
80% 100%
Crown Lengthening
Aesthetic assessment
Maxillary tooth aestheticsappraisal of the position of the maxillary central incisors relative to the upper lip
Determination of midline relationship/position
SURGICAL CONSIDERATION
S
Standard implantESTHETIC PLUS implant
2.8 mm1.8 mm
Standard vs. ESTHETIC PLUS
ESTETHIC PLUS Implant
≥ 6.2 mm ≥ 6.2 mm
WB 4.8 mm WNI 4.8 mm
≥ 5.5 mm
S 4.1 mm
≥ 4.8 mm ≥ 4.8 mm
NNI 3.3 mm S 3.3 mm
Ideal Implant placement in biotype I
Ideal Implant placement in biotype II
Biotype
Type 1 Type 2
Predicted
gingival margin
With these assessment criteria/protocols lets look at several cases to determine how to approach these to
ensure a good aesthetic and peri-implant health result.
HOW NOT TO DO IT!
TOO DEEP
TOO BUCCAL
Mc DENTISTRY
HOW DO YOU DO IT?
GOOD POSITION BUT
PROSTHETICS?
TOO DEEP
TOO SHALLOW
In Summary
Pre-surgical assessment should carried out prior to implant placement
Use surgical guides where possible
Consider temporary implant crowns in high aesthetic zones
NEVER bury implants
THANKYOU