DENTAL IMPLANT IN ESTHETIC ZONE

• INTRODUCTION:

NOWADAYS

osseointegrated implants are used, which have been proven to be totally biocompatible.

 Dental implant: is a "root" device, usually made of titanium (or may use zirconium), used in dentistry to support restorations that resemble a tooth or group of teeth to replace missing teeth.

Osseointegration: is a process refers to the direct fusion between mental implant surface and the healthy surrounding bone.

• DEFINITIONS:

• PARTS OF IMPLANT

1. Implant body 2. Healing screw3. Healing caps4. Abutments5. Impression post

• CLASSIFICATIONA. Depending on placement within the

tissue

subperiosteal implantEndosteal implant transosteal implant

B.Depending on materials used

Metallic ex: titanium

Non metallic ex: ceramic

C. Depending on design : screw shaped

Dental implants will fuse with bone; however they lack the periodontal ligament , so they will feel slightly different than natural teeth during chewing.

1. Uncontrolled diabetes2. Cardiovascular disorders3. Psychological disorders4. Systemic hematological disorders5. Smoking Drug and alcohol abuse6. Local pathology (root fragment, cyst, foreign

body, granuloma)7. Problematic occlusal and functional relationships8. Irradiation of jaws9. Osteoporosis/ low bone mineral content

• CONTRAINDICATION:

• ANTERIOR SPACES

midline

The influence of the lip position

position of the incisive canal

bone resorption in both a labial and vertical direction

Analysis of appropriate and adequate radiographs.

Analysis of mounted study models.

Measurement of bone and mucosal thickness.

• SPECIAL DIAGNOSTIC METHOD FOR IMPLANT PATIENT?

1. Analysis of appropriate and adequate radiographs.

Panoramic radiograph with templateLateral cephalometric radiograph

Computed tomography

2. Analysis of mounted study models.

3. Measurement of bone and mucosal thickness.

vernia

X-ray ruler

using sterile needle with rubber stop

• CRITICAL FACTOR FOR ESTHETIC ZONE IMPLANT RESTORATION

1. Width and height of available bone.

2. Soft tissue condition.3. Smile line.4. Color of teeth.5. Symmetry.6. Position of the implant.

SMILE LINEsmile line is defined as the relationship between the upper lip and the visibility of the gingival tissue and teeth. Its imaginary line following the lower margin of the upper lip and usually has a convex appearance ; it could be classified in to:

high average low

• The other line is formed by the bottom edge of the upper teeth. Ideally this line should follow the curvature of the lower lip.

• A straight flat line is less pleasing.

• A reverse curve where the front teeth appear to be shorter than the canines gives a look of aging and wear and can be quite unattractive.

• WHAT SPACE IS REQUIRED FOR PLACING IMPLANTS?

Preoperative measures

Flap less and Flap Designs

• THE SURGICAL PROCEDURE

Crestal flap

3 sided flap

Crestal flap

3 sided flap

For single tooth replacement, and If there is sufficient bone available also for esthetic reasons the mucoperiosteal flap should leave a 1mm margin of sound interdental papilla tissue to insure that it maintain fine . length of mucoperiosteal must not exceed two times its width in order not to compromise the blood supply.

Dr. PAUL A. FUGAZZOTTO (1998) noted the precise flap design should be governed according each individual situation, and not by an overall generic flap design. He categorized implant sites for single-tooth maxillary anterior placement as follows: Class I: Minimal or no ridge atrophy buccolingually or apicocoronally.

Class II: Minor buccolingual atrophy with no apicocoronally . Class IIA: Both minor buccolingual and apicocoronally atrophy. 

Class III: Moderate buccolingual ridge atrophy with no apicocoronal deficiency dehiscence and/or fenestration.

Class IIIA: The same as Class III, accompanied by moderate apicocoronal ridge atrophy. Class IV: Moderate-to-severe buccolingual ridge atrophy with or without an apicocoronal component; as a result, the hard tissue atrophy precludes ideal implant positioning and necessitates hard tissue augmentation prior to implant placement. 

• First using round as Pilot bur.• Twisted bur with triangular end to determine

the length.• Master bur which is round bur with blind end to

determine the width of the bone.

• During bone preparation, the temperature most not exceeds 43c because it causes osteocyte necrosis.

• Insertion of implant body and suture this will end the first stage fixture have to stay about 3 month in mandible and 5-6 month in maxilla.

• After that 2nd stage start which is exposed implant body again remove the cover screw and insert healing cap for up to 20 days after that the crown sealed and follow up vest start.

ISRAA ABD ALKAREEM AWADH