1 The Single Tooth Implant. The Ultimate Aesthetic Challenge

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1 1 The Single Tooth Implant The Ultimate Aesthetic Challenge by Daniel G. Pompa, D.D.S. 2 Before starting any Maxillary Anterior Single Implant, or any case in the esthetic zone: TAKE A PHOTO OF YOUR PATIENT WITH A SMILE! 3 Preventative Dentistry Operative Dentistry Restorative Dentistry Reconstructive Dentistry 4 T 5 JADA: JADA: Distance from contact point to crest of bone (mm) % of papilla filling in the embrasure The Tissue is the Issue especially if the

2 8 The Tissue is the Issue especially if the Bone is Gone 9 Biologic Width and Mechanical Stress 10 Biology Rules Platform Matching 13 Now we know there is a Horizontal component to Biologic Width 14 2 mm 15 Implant/Implant: no synergistic biologicic contribution Why Platform Switching.. The extent of bone resorption is related to both the texture of the surfaces of the implant and abutment at and the morphology of the implant-abutment junction (IAJ). A number of investigators have zeroed in on the proposed inflammatory cell infiltrate that forms a zone around the IAJ. Although not yet fully understood, the current theory of the benefit of platform switching is related to the physical repositioning of the IAJ away from the outer edge of the implant and the surrounding bone, thereby containing the inflammatory infiltrate within the width of the platform switch. It is the MAGNITUDE of the platform switch that really makes the difference in that when the difference is greater than 0.8mm there was a statistically significant difference in the level of bone maintenance. 19 Articles published.. Lazzara RJ, et al. Platform switching: A new concept in implant dentistry for controlling postoperative crestal bone levels. Int J Perio Rest Dent 2006;26:9-17 Ericsson I, et al. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Perio 1995;22:

3 Ericsson I, et al. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Perio 1995;22: Atieh MA, et al. Platform switching for marginal bone preservation around dental implants: A systematic review and meta-analysis. J Perio 2010;81: Block MS, 2009; Nov. 67(11): J Oral Maxillofacial Surgery Prospective evaluation of immediate and delayed provisional single tooth restorations Buser D, 2014; 29: Int J Oral Maxillofacial Implants Esthetic Outcomes following immediate and early implant placement in the anterior region - a systematic review 21 Recession as it relates to Implants year follow up Years Follow up 27 If no Buccal Plate - No Implant - Graft and Membrane If you have a good Buccal Plate: and want to maintain papillae igap i=immediate Implant G=Graft the Gap-Bio Oss - Xenograft A=Abutment-clean/sterile - Do not remove

4 G=Graft the Gap-Bio Oss - Xenograft A=Abutment-clean/sterile - Do not remove P=Provisional-Reestablish the contact point 28 Vertical Augmentation Bone Morphogenic Protein BMP-2 33 BMP Mechanism of Action 34 BMP Mechanism of Action Pre Op - Severe Atrophy 49 Meshwork to support bone graft with BMP 50 Post op with mesh

5 49 Meshwork to support bone graft with BMP 50 Post op with mesh 51 Pre/Post op CBCT Scan 52 Golden Rules Guide pins placed 2+,2+,3+,2+,2+ = X 4 = = 26 mm 54 Post op 55 Pre-Treatment Planning measurements from the palate with immediate implants If space is compromised or ridge is deficient place 3 of 4 with one Maxillary Central Multiple reasons -to create an ideal midline -to avoid the nasopalantine canal -for more ideal phonetics 61 Immediate Placement and Provisionalization

6 Using the actual Tooth as a Temp Indications for Immediate Implant and/or Removal 76 Early indications for removal, especially if younger (over 20y/o) Vertical Oblique Fracture If no Buccal Plate.No implant - Graft and Membrane. If Buccal Plate: and want to maintain papillae.. igap i=immediate Implant

7 83 If no Buccal Plate.No implant - Graft and Membrane. 84 If Buccal Plate: and want to maintain papillae.. igap i=immediate Implant G=Graft the Gap- Bio Oss - Xenograft A=Abutment-clean/sterile - do not remove P=Provisional-reestablish the contact point 85 Alternative options? 86 How to maintain gingival margin Today, that last case could have been perfect for orthodontic super-eruption Use of CAT Scan Technology Cone Beam Computerized Tomography (CBCT)

8 101 Use of CAT Scan Technology Cone Beam Computerized Tomography (CBCT) 102 Today with CBCT analysis the risk/benefit prior to surgery clearly shows that periapical surgery is contraindicated 103 Here we can see that the option of an orthograde and/or retrograde approach is acceptable, AND that the surgical approach has minimal risk of post op paresthesia 104 The difference in width for the buccal plate at the 2nd Molar vs. the 1st Molar position is both clinically and radiographically significant What will that look like on a Periapical Radiograph? with 1 1/2 mm on either side 113 Maxillary Central Why?? 114 1) Due to widened M-D width possibly requiring a Porclein Laminate be placed on the opposite Central 115 2) To avoid placement of the medial side of the implant against the nasopalantine canal 116 Prosthetics 117 Provisional options

9 With Clasps Without Clasps When you see and recognize a mistake.. correct it immediatly, as you own it until it s fixed

10 As a general rule, if you create a contact point 5mm or less from the crestal bone you will insure a papilla will exist in that embrasure 147 Distance from contact point to crest of bone (mm) % of papilla filling in the embrasure Soft Tissue Management Contact Point Index CPI Impression

11 156 Contact Point Index CPI Impression Impression to record and index the point of contact for maintenance of dental papallae 157 Soft Tissue Considerations Live as if you were to die tomorrow. Learn as if you were to live forever Mahatma Gandhi 171 For the PDF of To Pull or Not to Pull or The Single Tooth Implant

12 171 For the PDF of To Pull or Not to Pull or The Single Tooth Implant or visit the website: NVDS.org

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