The aesthetic zone represents the center stage for implant placement. This is true in a patient with a high lip-line when smiling as all aspects of implant treatment are immediately visible to the patient and all others who may interact with the patient. Treatment in the aesthetic zone is even more scrutinized than other areas of the mouth.
This month’s Implants Today focuses on dental implants in the aesthetic zone. The aesthetic zone represents the center stage for implant placement. This is true in a patient with a high lip-line when smiling as all aspects of implant treatment are immediately visible to the patient and all others who may interact with the patient. Treatment in the aesthetic zone is even more scrutinized when compared to treatment in other areas of the mouth. For example, the steps for provisionalization are a crucial aspect of treatment since the type of provisional and shape of the provisional can help set up the emergence profile of an implant site.
Implant Site Development (March 2012, Wiley-Blackwell) by Drs. Michael Sonick (an Implants Today advisory board member) and Debby Hwang covers the concept of setting up sites for implant placement in depth. It also includes chapters by other prominent experts, such as Drs. Craig Misch and Scott Ganz (also advisory board members). I recommend this textbook because site development is so important; just like constructing a building, each foundational step sets up for the success desired in the final result.
The multidisciplinary topics that must be taken into account with implant treatment in the aesthetic zone include but are not limited to: soft-tissue site development, vertical and horizontal bone augmentation concepts, socket preservation materials, immediate versus delayed placement, the role of a CBCT scan, growth factors, provisionalization options, emergence profile and abutment considerations, soft-tissue biotype assessment, and implant spacing and depth. This is a true merging of surgical and prosthetic principles, as treating a patient for tooth replacement in the aesthetic zone requires a sound understanding of many principles that must come together for success. This is why I personally enjoy implant dentistry so much—there is so much to know and implement clinically. When you approach treatment with this kind of respect, treatment becomes a true passion as a clinician. Our patients’ lives are being changed and everyone benefits. This is certainly an endeavor worth pursuing!
While the principles for implant treatment success in the aesthetic zone are used in other areas of the mouth, the anterior region mandates that almost every principle be used. As Dr. Carl Misch said, “Don’t place your first implant on a central incisor in a patient with a high lip-line!” Learn dental implant principles in less demanding areas of the mouth while building expertise and clinical skills. Lastly, don’t just read and watch; step in and do it! The best way to learn is to do and to experience.
This issue presents an outstanding article by Dr. Michael Sonick et al that sums up the many aspects of success mentioned here. Also, Drs. Todd Schoenbaum and Chandur Wadhwani contribute excellent content that focuses on the screw-retained versus cement-retained restorative options in the aesthetic zone, and Dr. Dino Javaheri presents a simplified chairside technique for both temporary fabrication and impression taking.