Presentation on theme: "Implant position: Its effect on implant aesthetics and health Dr Steven Soukoulis."— Presentation transcript:
Implant position: Its effect on implant aesthetics and health Dr Steven Soukoulis
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 ANATOMICAL FACTORS PROSTHETIC FACTORS
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
Aesthetics Maxillary incisor inclination Evaluate the labio-lingual inclination of the maxillary anterior teeth This can be done using: cephalometric radiographs or patients 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) ToothWidthLengthRatio (%) Central Incisor 8.59 mm (M) 8.06 mm (F) 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) Canine7.64 mm (M) 7.15 mm (F) 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)
Aesthetic assessment Maxillary tooth aesthetics appraisal of the position of the maxillary central incisors relative to the upper lip Determination of midline relationship/position
Standard implantESTHETIC PLUS implant 2.8 mm 1.8 mm Standard vs. ESTHETIC PLUS
ESTETHIC PLUS Implant
6.2 mm WB 4.8 mmWNI 4.8 mm 5.5 mm S 4.1 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 1Type 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
HOW DO YOU DO IT?
GOOD POSITION BUT PROSTHETICS?
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