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