Function & Esthetics

심미 기능적인 상악 전치부 임플란트 치료 입니다.

 


The use of SLock implant in the maxillary anterior region to replace missing teeth is a viable treatment option. There are many benefits of fixed dental implant-supported prosthetics versus traditional crown and bridge or removable tooth-borne prosthetics.1 Maintenance of residual bone, ease of oral hygiene, increased longevity, and noninvolvement of adjacent teeth are a few advantages of using dental implants. In order to provide successful and aesthetic dental implant treatment, certain clinical parameters must be met. This is particularly true in the anterior maxilla, where the teeth and their supporting structures are readily visible.

Successful implant treatment to replace missing teeth in the anterior maxilla requires preoperative planning and a specific surgical plan, and ultimately prostheses are fabricated in consideration of function and soft-tissue support.2 Technical expertise is also essential. Treatment planning must consider the final prosthetic result, so that implant surgery can be tailored to fulfill the preplanned objectives. Unless the position of the final prosthesis is visualized prior to surgery, the placement of the dental implants may not allow the desired end result to be achieved.3


Data that must be obtained to allow development of a proper treatment plan include probing depths and attachment levels for all remaining teeth, assessment of soft-tissue architecture, radiographic studies, study models, diagnostic wax-ups, and a comprehensive medical and dental history. Preoperative planning may indicate the need for an improved hard- and soft-tissue foundation prior to implant placement. Considerations for the creation of an ideal presurgical environment include atraumatic extractions, formation of papillae with ovate pontics, bone grafting with membranes, and connective tissue grafting.4 Ovate pontic placement after tooth extraction can create ideal papillae form prior to surgery, allowing for more predictable dental implant aesthetics.

The principles for maintaining a healthy biological width around natural teeth and implants should also be understood by the clinician. Provisional restoration of the treated area must also be considered. This last issue cannot be underestimated, since the provisional restoration is important for aesthetics and maintenance of hard- and soft-tissue form during an often lengthy treatment period.5


After a case has been planned, the implant surgery must be performed in consideration of ideal surgical technique, including conservative flap design, management of existing osseous architecture, correct spacing between adjacent implants or teeth, correct osteotomy preparation, and proper suturing techniques emphasizing primary closure.
Proper prosthetic concepts must also be followed to maximize aesthetics and function. The clinician must consider the time needed for implant integration and soft-tissue healing, creation of emergence profiles, occlusal forces in relationship to progressive loading, and occlusal forces on the final restoration.

This article will discuss the key concepts of treatment planning, implant surgery, and prosthetic rehabilitation needed to achieve aesthetic success in the maxillary anterior region.

TREATMENT PLANNING
The first step in treatment planning for a dental implant case is to determine the desired end result, specifically the prosthetic outcome. When the prosthetic result is clearly visualized, a clinician can then take the appropriate earlier steps to satisfy the patient needs.6 This approach is particularly important in the maxillary anterior aesthetic zone. Planning involves interactive conversation with the patient, which includes educating the patient about available prosthetic options. Models, still images, and videotapes are often utilized to convey this information. This focus on the prosthetic end result is multifactorial, and includes discussion of issues such as finance, treatment time, and provisionalization during treatment.

A comprehensive medical history must be obtained to determine if the patient is a candidate for implant surgery.7 Any uncontrolled medical condition or pregnancy requires a delay in treatment, consultation with the patient's physician, and appropriate follow-up. Habits such as smoking, alcohol use, or drug use should be addressed and taken into consideration prior to initiating treatment.

Recording and consideration of occlusal factors are essential. Bruxism, parafunctional activity, muscular dynamics, as well as tooth mobility should be taken into consideration.8 Mobile teeth adjacent to the implants can compromise an implant-based restoration due to the lack of occlusal support. Study models should be taken to assess the occlusal dynamics of the patient and also provide legal documentation. Study models can also offer information on the position of a tooth or teeth that might require orthodontic movement in order to create the correct spacing for implant placement. Radiographic analysis via a panoramic film, periapical films, and computerized tomography (CT) provide critical information pertaining to the osseous architecture and tooth position. CT is especially helpful for treatment planning in a 3-D perspective9 .



Often, radiopaque guide stents are used with a CT scan to define tooth position better. Observing the final tooth position in relation to the existing osseous architecture allows decisions to be reached with respect to the need for osseous grafting. This prosthetic relationship on a CT scan also may help determine if a removable prosthesis is needed to support the maxillary lip. If a large discrepancy on a CT exists between the final tooth position and the existing bone, then lip support via a denture flange may be indicated. The existing osseous architecture visualized on a CT scan can also indicate soft-tissue support. This support is essential in the aesthetic zone, since the presence of papillae will be dictated in part by the osseous support around a dental implant as well as by the distance between implants.18 Tarnow has suggested that unless there is a distance of 5 mm or less between the osseous crest of bone and the interproximal prosthetic contact point, papillae formation between crowns will be compromised.11 Therefore, it may be necessary to perform a bone graft prior to implant placement in order to achieve a more predictable aesthetic result.

Conclusions
Placing dental implants in the maxillary anterior region requires precise planning, surgery, and prosthetic treatment. This article has illustrated the steps needed to create ideal aesthetics in the maxillary anterior region. Rigorous treatment planning allows the implant surgeon, working with the restorative dentist, to select location, angulation, and spacing of dental implants to achieve ideal aesthetics. Treatment planning also dictates the necessity for hard- and soft-tissue grafting, which is often crucial for an ideal aesthetic result.


Further, the prosthetic restoration of a dental implant must be ideal to achieve the desired aesthetic result. This article has discussed the importance of a comprehensive and interdisciplinary approach to treatment planning, surgery, and restoration of dental implants in the maxillary anterior region of the mouth.

omfskim11@gmail.com, 2014.10.03 오전 11:51:41 | 3863 hit(s) 0 comment(s)
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