Advertisement

Parameters of Peri-Implant Aesthetics

  • Henriette LernerEmail author
Chapter

Abstract

Aim: The goal of the following is intended to provide a comprehensive overview of state-of-the-art peri-implant tissue management. This should empower the clinician to choose the most suitable method of implant therapy for a particular patient depending on the clinical findings, the tissue type, and his/her own surgical experience.

Summary: Over the past 50 years, implantology has evolved from an experimental treatment modality into a safe and effective method in dentistry. Today, in addition to osseointegration, aesthetics play a more and more important role including both white and pink aesthetics. The latter is controlled by an elaborate soft tissue management. This starts at the stage of tooth extraction and is perpetuated to the point of recall in the maintenance treatment. However, preserving marginal peri-implant tissues is more than adding improved aesthetics to successful osseointegration; vice versa, a state-of-the-art soft tissue management contributes to maintaining overall functional health and stability in the long term.

Key learning points: It is understood that bone thickness is a major factor in dental implantology. In addition, the periodontal soft tissue biotype should be given attention, as it is decisive for peri-implant soft tissue and bone stability. For example, an implant requires around itself 3 mm of tissue height/thickness and 3 mm of attached gingiva to allow for the buildup of a sufficient biological width; an initially thin biotype tissue will even compromise the buccal plate thickness. As a rule, minimally invasive surgical methods should be employed as well as abutment/crown designs for maximally tender soft tissue manipulation.

Keywords

Implantology Minimally invasive methods Immediate implant placement Immediate loading Soft tissue management Biological width Pink aesthetic score 

References

  1. Al-Nsour MM, Chan HL, Wang HL (2012) Effect of the platform-switching technique on preservation of peri-implant marginal bone: a systematic review. Int J Oral Maxillofac Implants 27(1):138–145PubMedGoogle Scholar
  2. Araújo MG, Lindhe J (2005) Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 32(2):212–218CrossRefGoogle Scholar
  3. Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D (2009) Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores. J Periodontol 80(1):140–151. doi: 10.1902/jop.2009.080435 CrossRefPubMedGoogle Scholar
  4. Berglundh T, Lindhe J (1991) Soft tissue barrier at implants and teeth. Clin Oral Implants Res 2:81–90CrossRefGoogle Scholar
  5. Buser D, Chappuis V, Bornstein MM, Wittneben JG, Frei M, Belser UC (2013) Long-term stability of contour augmentation with early implant placement following single tooth extraction in the esthetic zone: a prospective, cross-sectional study in 41 patients with a 5- to 9-year follow-up. J Periodontol 84(11):1517–1527. doi: 10.1902/jop.2013.120635 Epub 2013 Jan 24CrossRefPubMedGoogle Scholar
  6. Cabello G, Rioboo M, Fábrega JG (2013) Immediate placement and restoration of implants in the aesthetic zone with a trimodal approach: soft tissue alterations and its relation to gingival biotype. Clin Oral Implants Res 24(10):1094–1100CrossRefGoogle Scholar
  7. Capelli M, Testori T, Galli F, Zuffetti F, Motroni A, Weinstein R, Del Fabbro M (2013) Implant-buccal plate distance as diagnostic parameter: a prospective cohort study on implant placement in fresh extraction sockets. J Periodontol 84(12):1768–1774. doi: 10.1902/jop.2013.120474 Epub 2013 Mar 8CrossRefPubMedGoogle Scholar
  8. Caplanis N, Lozada JL, Kan JYK (2005) Extraction defect assessment, classification, and management. CDA J 33(11):853–863Google Scholar
  9. Chu SJ, Salama MA, Salama H, Garber DA, Saito H, Sarnachiaro GO, Tarnow DP (2012) The dual-zone therapeutic concept of managing immediate implant placement and provisional restoration in anterior extraction sockets. Compend Contin Educ Dent 33(7):524–532 534PubMedGoogle Scholar
  10. Cochran DL, Hermann JS, Schenk RK, Higginbottom FL, Buser D (1997) A histometric analysis of the implant-gingival junction around unloaded and loaded nonsubmerged implants in the canine mandible. J Periodontol 68:186–198CrossRefGoogle Scholar
  11. Fu JH, Wang HL (2011) Horizontal bone augmentation: the decision tree. Int J Periodontics Restor Dent 31(4):429–436Google Scholar
  12. Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G (2005) Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. Clin Oral Implants Res 16(6):639–644CrossRefGoogle Scholar
  13. Hermann JS, Schoolfield JD, Schenk RK, Buser D, Cochran DL (2001) Influence of the size of the microgap on crestal bone changes around titanium implants. A histometric evaluation of unloaded non-submerged implants in the canine mandible. J Periodontol 72(10):1372–1383CrossRefGoogle Scholar
  14. Hermann F, Lerner H, Palti A (2007) Factors influencing the preservation of the peri-implant marginal bone. Implant Dent 11:162–169Google Scholar
  15. Lerner H, Jacobson Z, Flax H (2012) Modified clinical approach for improved aesthetics in full-arch restoration. Cosmet Dent 4:34–37Google Scholar
  16. Linkevicius T, Puisys A, Vindasiute E, Linkeviciene L, Apse P (2013) Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res 24(11):1179–1184PubMedGoogle Scholar
  17. Mangano C, Iaculli F, Piattelli A, Mangano F (2014a) Fixed restorations supported by Morse-taper connection implants: a retrospective clinical study with 10–20 years of follow-up. Clin Oral Implants Res 00:1–8. doi: 10.1111/clr.12439 CrossRefGoogle Scholar
  18. Mangano F, Macchi A, Caprioglio A, Sammons RL, Piattelli A, Mangano C (2014b) Survival and complication rates of fixed restorations supported by locking-taper implants: a prospective study with 1 to 10 years of follow-up. J Prosthodont 23(6):434–444. doi: 10.1111/jopr.12152 CrossRefPubMedGoogle Scholar
  19. Misch CE (1998a) Non-functional immediate teeth in partially edentulous patients: a pilot study of 10 consecutive cases using the Maestro Dental Implant System. Compendium 19:25–36Google Scholar
  20. Misch CE (1998b) Non-functional immediate teeth. Dent Today 17:88–91PubMedGoogle Scholar
  21. Misch CE, Hahn J, Judy KW, Lemons JE, Linkow LI, Lozada JL, Mills E, Misch CM, Salama H, Shaarawy M, Testori T, Wang H-L (2004) Workshop guidelines on immediate loading in implant dentistry. J Oral Implant 30(5):283–288CrossRefGoogle Scholar
  22. Norton M (2013) Primary stability versus viable constraint – a need to redefine. Int J Oral Maxillofac Implants 28(1):19–21PubMedGoogle Scholar
  23. Redemagni M, Cremonesi S, Garlini G, Maiorana C (2009) Soft tissue stability with immediate implants and concave abutments. Eur J Esthet Dent 4(4):328–337PubMedGoogle Scholar
  24. Rodríguez X, Vela X, Méndez V, Segalà M, Calvo-Guirado JL, Tarnow DP (2013) The effect of abutment dis/reconnections on peri-implant bone resorption: a radiologic study of platform switched and non-platform-switched implants placed in animals. Clin Oral Implants Res 24(3):305–311. doi: 10.1111/j.1600-0501.2011.02317.x CrossRefPubMedGoogle Scholar
  25. Schmitt CM, Nogueira-Filho G, Tenenbaum HC, Lai JY, Brito C, Döring H, Nonhoff J (2014) Performance of conical abutment (Morse Taper) connection implants: a systematic review. J Biomed Mater Res A 102(2):552–574. doi: 10.1002/jbmm.34709 CrossRefPubMedGoogle Scholar
  26. Schnitman DA, Wohrle PS, Rubenstein JE, DaSilva JD, Wang NH (1997) Branemark implants immediately loaded with fixed prostheses at implant placement. Ten year results. Int J Oral Maxillofac Implants 12:495–503PubMedGoogle Scholar
  27. Schwartz-Arad D, Chaushu G (1999) Full-arch restoration of the jaw with fixed ceramo-metal prosthesis: late implant placement. J Periodontol 70(1):90–94CrossRefGoogle Scholar
  28. Su H, González-Martín O, Weisgold A, Lee E (2010) Considerations of implant abutment and crown contour: critical contour and subcritical contour. Int Periodontics Restor Dent 30(4):335–343Google Scholar
  29. Tarnow DP, Emtiag S, Classi A (1997) Immediate loading of threaded implants at stage one surgery in edentulous arches. Ten consecutive case reports with 1 to 5 year data. Int J Oral Maxillofac Implants 12:319–324PubMedGoogle Scholar
  30. Tarnow DP, Cho SC, Wallace SS (2000) The effect of the interimplant distance on the height of the interimplant bone crest. J Periodontol 71:546–549CrossRefGoogle Scholar
  31. Vera C, De Kok IJ, Reinhold D, Limpiphipatanakorn P, Yap AK, Tyndall D, Cooper LF (2012) Evaluation of buccal alveolar bone dimension of maxillary anterior and premolar teeth: a cone beam computed tomography investigation. Int J Oral Maxillofac Implants 27(6):1514–1519PubMedGoogle Scholar
  32. Wang HL, Ormianer Z, Palti A, Perel ML, Trisi P, Sammartino G (2006) Consensus conference on immediate loading: the single tooth and partial edentulous areas. Implant Dent 15:324–333CrossRefGoogle Scholar
  33. Wohrle P (1998) Single tooth replacement in the aesthetic zone with immediate provisionalization fourteen consecutive case reports. Pract Periodontics Aesthet Dent 9:1107–1114Google Scholar
  34. Yamane K, Ayukawa Y, Takeshita T, Furuhashi A, Yamashita Y, Koyano K (2013) Bacterial adhesion affinities of various implant abutment materials. Clin Oral Implants Res 24(12):1310–1315. doi: 10.1111/j.1600-0501.2012.02574.x CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.HL-DentclinicBaden-BadenGermany

Personalised recommendations