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
68 STOMA . EDUJ ( 2016 ) 3 ( 1 )