ORAL IMPLANTOLOGY
MODIFIED CLINICAL APPROACH FOR IMPROVED AESTHETICS IN FULL-ARCH RESTORATION
Henriette Lerner 1a *, Zhimon Jacobson 2b
1
HL-Dentclinic, Baden-Baden, Germany
2
Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine( GSDM), University of Boston, USA a
DMD, Associate Professor, Director HL-DENTCLINIC b
DMD, MSD, Clinical Professor
Cite this article: Lerner H, Jacobson Z. Modified clinical approach for improved aesthetics in full-arch restoration. Stoma Edu J. 2016; 3( 1): 68-74.
ABSTRACT
Received: 10 August 2015 Received in revised form: February 28, 2016
Accepted: 27 April 2016 Published online: January 19, 2016
Aim: to achieve a natural aesthetic outcome, function and stability using a minimally invasive, maximally effective technique in a reasonable time period. Summary: A 50-year-old female patient presented a tooth mobility of Grade II to III. She wished to have a full arch fixed aesthetic restoration. After evaluation of the hard and soft tissue and minimally invasive planning, the decision was made to modify the clinical approach and create a special protocol for best aesthetic results. The treatment includes chairside and laboratory steps, such as aesthetic analysis, impressions, a functional analysis, X-rays, CT, and evaluation of the hard and soft tissue, a mock-up of the intended result and minimally invasive planning. The patient was happy with the desired outcome. Key learning points: 1. Improved aesthetic results for full arch restorations are achieved by immediate implant placement, immediate loading and platform switching. 2. Platform switching implant design, provisional and final abutment design, and paradigm shifts in treatment approaches lead to superior aesthetic results. 3. Thorough evaluation and manipulation of the hard and soft tissue provide the desired aesthetic outcome. Keywords: aesthetic implantology, pink and white aesthetics, full arch restoration, inter-implant papilla length, platform-switching.
1. Introduction
This case study demonstrates that new philosophies concerning implant design, provisional and final abutment design, as well as paradigm shifts in treatment approaches, can lead to superior aesthetic results. In full-arch implant-supported restoration, immediate placement with immediate loading has been well documented. The literature shows a high success rate of 97 % with this kind of treatment in the mandible 11-17 and of 96 % in the maxilla. 18-20 Osseointegration of implants has been achieved routinely and with a high degree of success. Contemporary implant dentistry focuses on aesthetic success aside from functional results. One of the compromises in aesthetics in a situation of adjacent implants is the short papilla between two implants, where a maximum length of 3.5 mm can be achieved. 1 This can be explained by loss of the inter-implant bone. The advantages of a platform-switched implant design regarding bone and tissue stability are well documented in literature. 2-6 The resulting stability of the bone is explained through the increased distance of the micro-gap from the bone( a minimum of 0.45 mm is adequate). Another way to preserve bone in the long term is by selecting an implant design with a micro-thread design at the collar. The positive influence of the micro-thread design at the collar of the implant has been biomechanically explained by Steigenga et al. 7 Bone is stronger when loaded in compression, and 30 % weaker when subjected to tensile forces. During function, the shear forces are transformed into small compression and traction forces.
2. Papillary area
Another observed benefit of platform-switching is the non-surgical increase in tissue volume in the healing phase. Additionally, Gargiulio 8 has demonstrated that the
* Corresponding author: Associate Professor Henriette Lerner, DMD, Director HL-Dentclinic Ludwig-Wilhelm-Straße 17, D-76530 Baden-Baden, Germany Phone: + 49( 0) 7221.398730, Fax: + 49( 0) 7221.3987310, e-mail: info @ hl-dentclinic. de
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